Provider Demographics
NPI:1942287743
Name:HALL, TINA D (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:D
Last Name:HALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 FRESHOUR ST
Mailing Address - Street 2:STE A
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2210
Mailing Address - Country:US
Mailing Address - Phone:423-581-1479
Mailing Address - Fax:423-586-7488
Practice Address - Street 1:1050 FRESHOUR ST
Practice Address - Street 2:STE A
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2210
Practice Address - Country:US
Practice Address - Phone:423-581-1479
Practice Address - Fax:423-586-7488
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6650363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4066177OtherBLUE CROSS BLUE SCHEILD
TN1513604Medicaid
P92543Medicare UPIN
TN1513604Medicaid
TN4066177OtherBLUE CROSS BLUE SCHEILD