Provider Demographics
NPI:1821515032
Name:TINA JOY APRN-CNP, FNP-BC, LLC
Entity Type:Organization
Organization Name:TINA JOY APRN-CNP, FNP-BC, LLC
Other - Org Name:BOULEVARD FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER, PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:JOY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:405-312-2775
Mailing Address - Street 1:3431 S BOULEVARD STE 109
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5514
Mailing Address - Country:US
Mailing Address - Phone:405-562-1870
Mailing Address - Fax:405-562-1871
Practice Address - Street 1:3431 S BOULEVARD STE 109
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5514
Practice Address - Country:US
Practice Address - Phone:405-562-1870
Practice Address - Fax:405-562-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK77055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK77055OtherAPRN-CNP
OK2015022832OtherANCC