Provider Demographics
NPI:1851045017
Name:POFFENBERGER, TINA A
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:A
Last Name:POFFENBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38721 FOXHALL RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19945-4630
Mailing Address - Country:US
Mailing Address - Phone:443-206-1522
Mailing Address - Fax:
Practice Address - Street 1:38721 FOXHALL RD
Practice Address - Street 2:
Practice Address - City:FRANKFORD
Practice Address - State:DE
Practice Address - Zip Code:19945-4630
Practice Address - Country:US
Practice Address - Phone:443-206-1522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator