Provider Demographics
NPI:1760632434
Name:FOX, TINA MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:FOX
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7155 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-0802
Mailing Address - Country:US
Mailing Address - Phone:423-648-9290
Mailing Address - Fax:423-648-9291
Practice Address - Street 1:7155 LEE HWY STE 300
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-0802
Practice Address - Country:US
Practice Address - Phone:423-553-7560
Practice Address - Fax:423-648-9291
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNF0808413363LF0000X
TNAPN0000013774363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509962Medicaid
TN4356876OtherBCBS OF TENNESSEE
TN4356876OtherBCBS OF TENNESSEE
TN103I503568Medicare PIN