Provider Demographics
NPI:1528039153
Name:WARREN, TINA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:MARIE
Last Name:WARREN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9785 CROSSHILL BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-5823
Mailing Address - Country:US
Mailing Address - Phone:904-772-6522
Mailing Address - Fax:904-772-6553
Practice Address - Street 1:9785 CROSSHILL BLVD STE 108
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-5823
Practice Address - Country:US
Practice Address - Phone:904-772-6522
Practice Address - Fax:904-772-6553
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381601000Medicaid
FLP00007425OtherRAILROAD MEDICARE
FL55876OtherBCBS
FL55876AMedicare ID - Type Unspecified