Provider Demographics
NPI:1558380246
Name:SCHAFFER, TINA M (ANP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:ANP
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 2451
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61702-2451
Mailing Address - Country:US
Mailing Address - Phone:309-268-2172
Mailing Address - Fax:309-268-3649
Practice Address - Street 1:105 S MAJOR ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:IL
Practice Address - Zip Code:61530-1246
Practice Address - Country:US
Practice Address - Phone:309-467-4691
Practice Address - Fax:309-467-6229
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005632363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
10215111OtherBLUE CROSS BLUE SHIELD
IL374440Medicare ID - Type UnspecifiedMEDICARE GROUP SCM
10215111OtherBLUE CROSS BLUE SHIELD
IL748943Medicare ID - Type UnspecifiedMEDICARE GROUP EP
K23074Medicare ID - Type Unspecified
IL712180Medicare ID - Type UnspecifiedMEDICARE GROUP TCH
IL748940Medicare ID - Type UnspecifiedMEDICARE GROUP HPT
ILK30956Medicare ID - Type UnspecifiedMEDICARE PIN INT
ILK30961Medicare ID - Type UnspecifiedMEDICARE PIN LEX
IL206706Medicare ID - Type UnspecifiedMEDICARE GROUP LFM
IL748942Medicare ID - Type UnspecifiedMEDICARE GROUP LEX
ILK30959Medicare ID - Type UnspecifiedMEDICARE PIN LFM
ILK30957Medicare ID - Type UnspecifiedMEDICARE PIN FMA
ILK30958Medicare ID - Type UnspecifiedMEDICARE PIN SCM
ILK30965Medicare ID - Type UnspecifiedMEDICARE PIN EP
IL200871Medicare ID - Type UnspecifiedMEDICARE GROUP INT
ILK30960Medicare ID - Type UnspecifiedMEDICARE PIN HPT