Provider Demographics
NPI:1629515531
Name:FLORES, TINA (ARNP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1211 N 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-1347
Mailing Address - Country:US
Mailing Address - Phone:509-454-8888
Mailing Address - Fax:509-453-0061
Practice Address - Street 1:1211 N 16TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-1347
Practice Address - Country:US
Practice Address - Phone:509-454-8888
Practice Address - Fax:509-453-0061
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60726500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP60726500OtherWA AP LICENSE