Provider Demographics
NPI:1891189197
Name:SMITH, TINA LAVETTE
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:LAVETTE
Last Name:SMITH
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 1:340 N SAM HOUSTON PKWY E STE 243
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-3394
Mailing Address - Country:US
Mailing Address - Phone:832-499-9875
Mailing Address - Fax:866-593-3931
Practice Address - Street 1:340 N SAM HOUSTON PKWY E STE 243
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3394
Practice Address - Country:US
Practice Address - Phone:832-499-9875
Practice Address - Fax:866-593-3931
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health