Provider Demographics
NPI:1851374102
Name:DAVIS, TINA M (CRNP)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:ZERBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:217 HARRISBURG AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2964
Mailing Address - Country:US
Mailing Address - Phone:717-397-5484
Mailing Address - Fax:717-481-7397
Practice Address - Street 1:217 HARRISBURG AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2964
Practice Address - Country:US
Practice Address - Phone:717-397-5484
Practice Address - Fax:717-481-7397
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005755B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
032347Medicare ID - Type Unspecified
S91425Medicare UPIN