Provider Demographics
NPI:1467191650
Name:ACQUAVIVA, TINA (HEALTH COACH)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:ACQUAVIVA
Suffix:
Gender:F
Credentials:HEALTH COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 LUNA BELLA LN APT 321
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-4522
Mailing Address - Country:US
Mailing Address - Phone:703-581-5972
Mailing Address - Fax:
Practice Address - Street 1:434 LUNA BELLA LN APT 321
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-4522
Practice Address - Country:US
Practice Address - Phone:703-581-5972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach