Provider Demographics
NPI:1518296375
Name:HENDRICKS, TINA DENISE (RN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:DENISE
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:DENISE
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:157 PARAGON PKWY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-9481
Mailing Address - Country:US
Mailing Address - Phone:828-452-6675
Mailing Address - Fax:828-452-6730
Practice Address - Street 1:157 PARAGON PKWY
Practice Address - Street 2:SUITE 800
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-9481
Practice Address - Country:US
Practice Address - Phone:828-452-6675
Practice Address - Fax:828-452-6730
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235799163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse