Provider Demographics
NPI:1710675459
Name:CARRINGTON, TINA MARIE
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:CARRINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:BOONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 GLASTONBURY DR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-7020
Mailing Address - Country:US
Mailing Address - Phone:603-484-9542
Mailing Address - Fax:
Practice Address - Street 1:25 GLASTONBURY DR
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-7020
Practice Address - Country:US
Practice Address - Phone:603-484-9542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNHL13677505172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver