Provider Demographics
NPI:1417273210
Name:MACKLIN, TINA MARIE
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:MACKLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7466 HAZEL AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63143-3028
Mailing Address - Country:US
Mailing Address - Phone:314-323-4032
Mailing Address - Fax:314-383-5453
Practice Address - Street 1:7466 HAZEL AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MO
Practice Address - Zip Code:63143-3028
Practice Address - Country:US
Practice Address - Phone:314-323-4032
Practice Address - Fax:314-383-5453
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care