Provider Demographics
NPI:1962487173
Name:VEST, TINA M (MSN, APRN, BC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:VEST
Suffix:
Gender:F
Credentials:MSN, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 PINE LAKE RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6009
Mailing Address - Country:US
Mailing Address - Phone:402-817-0897
Mailing Address - Fax:402-817-0901
Practice Address - Street 1:2935 PINE LAKE RD
Practice Address - Street 2:SUITE F
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6009
Practice Address - Country:US
Practice Address - Phone:402-817-0897
Practice Address - Fax:402-817-0901
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110505101YM0800X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025323700Medicaid