Provider Demographics
NPI:1437476165
Name:WILLIAMS, TINA RENEE (CNA)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:RENEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 SHAWEN DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-2286
Mailing Address - Country:US
Mailing Address - Phone:757-725-8687
Mailing Address - Fax:
Practice Address - Street 1:341 SHAWEN DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-2286
Practice Address - Country:US
Practice Address - Phone:757-725-8687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401135825376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide