Provider Demographics
NPI:1508921388
Name:ALMANZA, TINA MARCIA (PPCNP-BC, MSN, AE-C)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARCIA
Last Name:ALMANZA
Suffix:
Gender:F
Credentials:PPCNP-BC, MSN, AE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E BOSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1321
Mailing Address - Country:US
Mailing Address - Phone:313-287-0123
Mailing Address - Fax:
Practice Address - Street 1:1903 WILKINS ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-2112
Practice Address - Country:US
Practice Address - Phone:313-833-1100
Practice Address - Fax:313-832-5531
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITA151924363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI77 4668008Medicaid