Provider Demographics
NPI:1679233316
Name:SLAVICK, TINA LOUISE
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:LOUISE
Last Name:SLAVICK
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 1:8311 N VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-3561
Mailing Address - Country:US
Mailing Address - Phone:508-822-6068
Mailing Address - Fax:
Practice Address - Street 1:8311 N VIEW BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-3561
Practice Address - Country:US
Practice Address - Phone:508-822-6068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula