Provider Demographics
NPI:1760653372
Name:TRABER, TINA M (NP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:TRABER
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 1:18914 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8348
Mailing Address - Country:US
Mailing Address - Phone:716-982-9905
Mailing Address - Fax:907-257-7493
Practice Address - Street 1:2581 CLYDE AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7508
Practice Address - Country:US
Practice Address - Phone:814-943-8164
Practice Address - Fax:814-940-7864
Is Sole Proprietor?:No
Enumeration Date:2008-03-23
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304807363LA2200X
AK104901363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1760653372OtherMEDICARE RAILROAD NUMBER
NY1760653372OtherMEDICARE RAILROAD NUMBER