Provider Demographics
NPI:1629746409
Name:ELDRIGE, TINA MICHELLE
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:MICHELLE
Last Name:ELDRIGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1864 S HALL
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6887
Mailing Address - Country:US
Mailing Address - Phone:928-581-2636
Mailing Address - Fax:
Practice Address - Street 1:1864 S HALL
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6887
Practice Address - Country:US
Practice Address - Phone:928-581-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN190854163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse