Provider Demographics
NPI:1407822182
Name:KAUFMAN, TINA M (PA-C)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:CARDIOLOGY @UHN62
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-8750
Mailing Address - Fax:503-494-8550
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:CARDIOLOGY @UHN62
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-8750
Practice Address - Fax:503-494-8550
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01773363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180162301Medicaid
TX8N4896OtherBLUE CROSS BLUE SHIELD
TX82N830Medicare PIN
TX8N4896OtherBLUE CROSS BLUE SHIELD