Provider Demographics
NPI:1942909312
Name:TALLINA, ADRIENNE ELISABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:ELISABETH
Last Name:TALLINA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ADRIENNE
Other - Middle Name:ELISABETH
Other - Last Name:ORLANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2014 MYRTLE OAK CT
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3266
Mailing Address - Country:US
Mailing Address - Phone:936-499-7468
Mailing Address - Fax:
Practice Address - Street 1:22710 PROFESSIONAL DR STE 202
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6009
Practice Address - Country:US
Practice Address - Phone:281-312-8521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA16556363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant