Provider Demographics
NPI:1902374655
Name:WEBB, TINA MARIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:WEBB
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SHORTLY STONE RD
Mailing Address - Street 2:
Mailing Address - City:ATKINS
Mailing Address - State:VA
Mailing Address - Zip Code:24311-3266
Mailing Address - Country:US
Mailing Address - Phone:304-952-9217
Mailing Address - Fax:
Practice Address - Street 1:8494 S SCENIC HWY STE D
Practice Address - Street 2:
Practice Address - City:BLAND
Practice Address - State:VA
Practice Address - Zip Code:24315-5255
Practice Address - Country:US
Practice Address - Phone:276-688-0500
Practice Address - Fax:276-688-3200
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily