Provider Demographics
NPI:1962627521
Name:WHITE, TINIKI R (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TINIKI
Middle Name:R
Last Name:WHITE
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:250 HUFF DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7369
Mailing Address - Country:US
Mailing Address - Phone:910-353-4414
Mailing Address - Fax:910-353-2972
Practice Address - Street 1:250 HUFF DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7369
Practice Address - Country:US
Practice Address - Phone:910-353-4414
Practice Address - Fax:910-353-2972
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-00152363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant