Provider Demographics
NPI:1790191369
Name:RIGGS, TINA (ANP-C, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:RIGGS
Suffix:
Gender:F
Credentials:ANP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2227
Mailing Address - Country:US
Mailing Address - Phone:631-833-8109
Mailing Address - Fax:
Practice Address - Street 1:1227 MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2227
Practice Address - Country:US
Practice Address - Phone:631-833-8109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307044-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF405096-01OtherPSYCHIATRY