Provider Demographics
NPI:1851743645
Name:MATHENIA, TINA (APRN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:MATHENIA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 GALL BLVD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-1347
Mailing Address - Country:US
Mailing Address - Phone:813-779-1209
Mailing Address - Fax:813-779-1216
Practice Address - Street 1:7050 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-1347
Practice Address - Country:US
Practice Address - Phone:813-779-1209
Practice Address - Fax:813-779-1216
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004758363LF0000X
FLAPRN11016572363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily