Provider Demographics
NPI:1922453059
Name:HOWARD, TINA MARIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1787 ALLENDALE FAIRFAX HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:SC
Mailing Address - Zip Code:29827-9133
Mailing Address - Country:US
Mailing Address - Phone:803-584-2128
Mailing Address - Fax:803-584-2125
Practice Address - Street 1:623 MEMORIAL AVE N
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:SC
Practice Address - Zip Code:29810-2715
Practice Address - Country:US
Practice Address - Phone:803-584-2128
Practice Address - Fax:803-584-2125
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily