Provider Demographics
NPI:1467882829
Name:DZIENKIEWICZ, TINAMARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:TINAMARIE
Middle Name:
Last Name:DZIENKIEWICZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TINAMARIE
Other - Middle Name:
Other - Last Name:GREGORIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA -C
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:641 US HIGHWAY 130
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08691-2101
Practice Address - Country:US
Practice Address - Phone:609-568-9383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00323100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant