Provider Demographics
NPI:1861019028
Name:NELAN, TINA (CPT)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:NELAN
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MARYS LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-5629
Mailing Address - Country:US
Mailing Address - Phone:631-800-4111
Mailing Address - Fax:631-204-6842
Practice Address - Street 1:208 MARYS LN
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5629
Practice Address - Country:US
Practice Address - Phone:631-800-4111
Practice Address - Fax:631-204-6842
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYD3Y4A2S6246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy