Provider Demographics
NPI:1467984237
Name:WADE, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:WADE
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 1:40421 MILFORD DR
Mailing Address - Street 2:
Mailing Address - City:BROADLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4527
Mailing Address - Country:US
Mailing Address - Phone:703-625-3815
Mailing Address - Fax:
Practice Address - Street 1:44927 GEORGE WASHINGTON BLVD STE 265
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4294
Practice Address - Country:US
Practice Address - Phone:703-625-3815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health