Provider Demographics
NPI:1609352400
Name:MOY, TINA M (LPN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:MOY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:GROCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:445 E DUBLIN GRANVILLE RD STE G
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3183
Mailing Address - Country:US
Mailing Address - Phone:614-844-4380
Mailing Address - Fax:614-844-6258
Practice Address - Street 1:445 E DUBLIN GRANVILLE RD STE G
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3183
Practice Address - Country:US
Practice Address - Phone:614-844-3800
Practice Address - Fax:614-844-6258
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-14
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.161413.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1609352400Medicaid