Provider Demographics
NPI:1639693468
Name:WAUGH, TINA L (APRN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:L
Last Name:WAUGH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:WV
Mailing Address - Zip Code:25434-0002
Mailing Address - Country:US
Mailing Address - Phone:304-947-5500
Mailing Address - Fax:304-947-5563
Practice Address - Street 1:783 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:WV
Practice Address - Zip Code:25434
Practice Address - Country:US
Practice Address - Phone:304-947-5500
Practice Address - Fax:304-947-5563
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN94035-NP-C363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care