Provider Demographics
NPI:1679704373
Name:SHORE, TINA MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:SHORE
Suffix:
Gender:F
Credentials:CRNA
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 3945
Mailing Address - Street 2:DEPT#841
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77253-3945
Mailing Address - Country:US
Mailing Address - Phone:281-358-8114
Mailing Address - Fax:281-358-0609
Practice Address - Street 1:4000 SPENCER HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1202
Practice Address - Country:US
Practice Address - Phone:713-359-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX537181163W00000X
TXAP122515367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse