Provider Demographics
NPI:1568730570
Name:DEMURE, TINA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:DEMURE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:GUZIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:30 S VALLEY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1469
Mailing Address - Country:US
Mailing Address - Phone:910-578-8785
Mailing Address - Fax:
Practice Address - Street 1:30 S VALLEY RD STE 101
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1469
Practice Address - Country:US
Practice Address - Phone:267-358-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN777514163W00000X
AK120538363L00000X, 363LF0000X
AK118602163W00000X
PASP028186363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1669161Medicaid