Provider Demographics
NPI:1669837613
Name:EDUVIE, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:EDUVIE
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 1:514 BEACH 65TH ST
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1329
Mailing Address - Country:US
Mailing Address - Phone:347-495-8241
Mailing Address - Fax:
Practice Address - Street 1:514 BEACH 65TH ST
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1329
Practice Address - Country:US
Practice Address - Phone:347-495-8241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321523164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse