Provider Demographics
NPI:1043006117
Name:SMITH, TINA YVONNE
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:YVONNE
Last Name:SMITH
Suffix:
Gender:
Credentials:
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:YVONNE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 PROMENADE BLVD APT 2125
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2864
Mailing Address - Country:US
Mailing Address - Phone:702-517-4027
Mailing Address - Fax:
Practice Address - Street 1:3930 HOWARD HUGHES PKWY STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-0946
Practice Address - Country:US
Practice Address - Phone:702-560-2192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide