Provider Demographics
NPI:1790349884
Name:TRUONG, TINA (RN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:TRUONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-1842
Mailing Address - Fax:503-418-5055
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:UHS-8L
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-1842
Practice Address - Fax:503-418-4079
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201403013RN163W00000X, 163WC0400X, 163WC1500X
OR202208005NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health