Provider Demographics
NPI:1972605657
Name:BOYLES, TINA SALTER (NP)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:SALTER
Last Name:BOYLES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:SALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1001 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2161
Mailing Address - Country:US
Mailing Address - Phone:601-663-1269
Mailing Address - Fax:601-663-1286
Practice Address - Street 1:1001 HOLLAND AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350
Practice Address - Country:US
Practice Address - Phone:601-656-1465
Practice Address - Fax:601-656-2752
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR861295363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner