Provider Demographics
NPI:1477059707
Name:PHILLIPS, TINA ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 COLONY DR APT 57
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-6476
Mailing Address - Country:US
Mailing Address - Phone:740-683-5230
Mailing Address - Fax:
Practice Address - Street 1:842 ARCH ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-5704
Practice Address - Country:US
Practice Address - Phone:740-683-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH097033164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse