Provider Demographics
NPI:1023240587
Name:DAVIS-LARKIN, TINA M (APN)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:DAVIS-LARKIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8043 S FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-2717
Mailing Address - Country:US
Mailing Address - Phone:708-684-4116
Mailing Address - Fax:708-684-4272
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-684-4116
Practice Address - Fax:708-684-4272
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006718163WX0002X, 163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk