Provider Demographics
NPI:1508433756
Name:CUNNINGHAM, TINA GAIL (LVN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:GAIL
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6303 W SHADY SHORES RD APT 516
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5546
Mailing Address - Country:US
Mailing Address - Phone:817-600-0181
Mailing Address - Fax:
Practice Address - Street 1:6303 W SHADY SHORES RD APT 516
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-5546
Practice Address - Country:US
Practice Address - Phone:817-600-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX197028164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse