Provider Demographics
NPI:1619360526
Name:MILLER, TINA L
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:41 SMOKEY RUN DR
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-1538
Mailing Address - Country:US
Mailing Address - Phone:856-296-8829
Mailing Address - Fax:856-809-2746
Practice Address - Street 1:41 SMOKEY RUN DR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-1538
Practice Address - Country:US
Practice Address - Phone:856-296-8829
Practice Address - Fax:856-809-2746
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO07374300163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care