Provider Demographics
NPI:1629078829
Name:HOOVER, TINA NADINE (ADULT NURSE PRACTITI)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:NADINE
Last Name:HOOVER
Suffix:
Gender:F
Credentials:ADULT NURSE PRACTITI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 E MANOR DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-2614
Mailing Address - Country:US
Mailing Address - Phone:520-423-1954
Mailing Address - Fax:520-876-5794
Practice Address - Street 1:900 E FLORENCE BLVD
Practice Address - Street 2:STE. H
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-4666
Practice Address - Country:US
Practice Address - Phone:520-836-4382
Practice Address - Fax:520-876-5794
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN022497363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMHO344818OtherDEA
AZVAD000Medicare UPIN