Provider Demographics
NPI:1518079086
Name:THROOP, TINA R (NP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:R
Last Name:THROOP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 APPLEGATE LN
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1668
Mailing Address - Country:US
Mailing Address - Phone:810-407-0999
Mailing Address - Fax:
Practice Address - Street 1:812 BRADLEY ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2552
Practice Address - Country:US
Practice Address - Phone:989-729-4220
Practice Address - Fax:989-729-4230
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704174012363L00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1518079086Medicaid
MI1518079086Medicaid
MIN85210004Medicare PIN