Provider Demographics
NPI:1558756361
Name:SMITH, TINA MARCEL (LPN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARCEL
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 FOUNTAIN LN
Mailing Address - Street 2:APT. A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4159
Mailing Address - Country:US
Mailing Address - Phone:614-318-3804
Mailing Address - Fax:
Practice Address - Street 1:1095 FOUNTAIN LN
Practice Address - Street 2:APT A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4159
Practice Address - Country:US
Practice Address - Phone:614-318-3804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-144268-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse