Provider Demographics
NPI:1689991770
Name:PERRY, TINA (NP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7075 N MAPLE AVE
Mailing Address - Street 2:STE. 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-8014
Mailing Address - Country:US
Mailing Address - Phone:559-299-8800
Mailing Address - Fax:559-299-9944
Practice Address - Street 1:7075 N. MAPLE
Practice Address - Street 2:STE. 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-299-8800
Practice Address - Fax:559-299-9944
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19740363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health