Provider Demographics
NPI:1629146022
Name:HEYWARD, TINA MARIE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:HEYWARD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14409 GREENVIEW DR 101A
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3293
Mailing Address - Country:US
Mailing Address - Phone:301-725-0788
Mailing Address - Fax:301-725-2779
Practice Address - Street 1:14409 GREENVIEW DR 101A
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3293
Practice Address - Country:US
Practice Address - Phone:301-725-0788
Practice Address - Fax:301-725-2779
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2015-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR095262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
007200M92Medicare ID - Type Unspecified
P30606Medicare UPIN
MD007200M92Medicare PIN