Provider Demographics
NPI:1558149575
Name:GARZELLA, TINA ROSEMARY
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:ROSEMARY
Last Name:GARZELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49734-0398
Mailing Address - Country:US
Mailing Address - Phone:989-732-6448
Mailing Address - Fax:989-731-0670
Practice Address - Street 1:403 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1887
Practice Address - Country:US
Practice Address - Phone:989-732-6448
Practice Address - Fax:989-731-0670
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator