Provider Demographics
NPI:1891843256
Name:WILLER, TINA (PA-C, ATC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:WILLER
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:WILHARM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-467-7078
Mailing Address - Fax:319-353-8430
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-467-7078
Practice Address - Fax:319-353-8430
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL960019802255A2300X
IA002058363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical