Provider Demographics
NPI:1689092116
Name:FLOYD, TINA MARIE (RDHAP)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:FLOYD
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 SIERRA ST
Mailing Address - Street 2:BOX 157
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-1554
Mailing Address - Country:US
Mailing Address - Phone:559-250-3969
Mailing Address - Fax:
Practice Address - Street 1:968 SIERRA ST
Practice Address - Street 2:BOX 157
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-1554
Practice Address - Country:US
Practice Address - Phone:559-250-3969
Practice Address - Fax:559-897-5201
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22464124Q00000X
CA522124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist