Provider Demographics
NPI:1508898297
Name:SMITH, TINA M (CRNA)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:338 HARRIS HILL RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7470
Mailing Address - Country:US
Mailing Address - Phone:716-634-4798
Mailing Address - Fax:716-634-0987
Practice Address - Street 1:550 ORCHARD PARK RD
Practice Address - Street 2:SUITE 101B
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2646
Practice Address - Country:US
Practice Address - Phone:716-677-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2010-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY370153-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC9029Medicare PIN
NYS19153Medicare UPIN