Provider Demographics
NPI:1700403128
Name:WILDER SLIGER, TINA MICHELLE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MICHELLE
Last Name:WILDER SLIGER
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 ARROWHEAD RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-3675
Mailing Address - Country:US
Mailing Address - Phone:501-762-3691
Mailing Address - Fax:
Practice Address - Street 1:3525 AR-5
Practice Address - Street 2:SUITE 200
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72019
Practice Address - Country:US
Practice Address - Phone:501-333-6654
Practice Address - Fax:833-906-2595
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR125504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty