Provider Demographics
NPI:1821606245
Name:COOK, TINA LOUISE (CAREGIVER)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:LOUISE
Last Name:COOK
Suffix:
Gender:F
Credentials:CAREGIVER
Other - Prefix:MRS
Other - First Name:TINA
Other - Middle Name:LOUISE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPR/FIRST AID
Mailing Address - Street 1:64 HILLSDALE CT
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:WV
Mailing Address - Zip Code:25208-9631
Mailing Address - Country:US
Mailing Address - Phone:304-247-6478
Mailing Address - Fax:
Practice Address - Street 1:64 HILLSDALE CT
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:WV
Practice Address - Zip Code:25208-9631
Practice Address - Country:US
Practice Address - Phone:304-247-6514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant