Provider Demographics
NPI:1497445217
Name:MALEC, TINA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:MALEC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 CLYDESDALE DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-7591
Mailing Address - Country:US
Mailing Address - Phone:717-817-9087
Mailing Address - Fax:
Practice Address - Street 1:705 CLYDESDALE DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-7591
Practice Address - Country:US
Practice Address - Phone:717-817-9087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN557607163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse