Provider Demographics
NPI:1760023386
Name:BECKENDORF, TINA RENAE (CSFA)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:RENAE
Last Name:BECKENDORF
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 AN COUNTY ROAD 476
Mailing Address - Street 2:
Mailing Address - City:TENNESSEE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75861-3558
Mailing Address - Country:US
Mailing Address - Phone:903-731-3220
Mailing Address - Fax:
Practice Address - Street 1:781 AN COUNTY ROAD 476
Practice Address - Street 2:
Practice Address - City:TENNESSEE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75861-3558
Practice Address - Country:US
Practice Address - Phone:903-731-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant