Provider Demographics
NPI:1417227745
Name:OVERSTREET, TINA MARIE (BA, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:OVERSTREET
Suffix:
Gender:F
Credentials:BA, PA-C
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, PA-C
Mailing Address - Street 1:1792 N DEWITT AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-7516
Mailing Address - Country:US
Mailing Address - Phone:559-905-1661
Mailing Address - Fax:
Practice Address - Street 1:3152 N MILLBROOK AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1400
Practice Address - Country:US
Practice Address - Phone:559-244-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1099313363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant