Provider Demographics
NPI:1942919600
Name:GASKILL, TINA MARIE
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:GASKILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 LEESON AVE
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-1558
Mailing Address - Country:US
Mailing Address - Phone:567-259-9271
Mailing Address - Fax:
Practice Address - Street 1:944 LEESON AVE
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-1558
Practice Address - Country:US
Practice Address - Phone:567-259-9271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000000376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker