Provider Demographics
NPI:1154760304
Name:MYERS, TINA MARIA (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIA
Last Name:MYERS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:MARIA
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:330 60TH ST
Mailing Address - Street 2:ROOM 123
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3720
Mailing Address - Country:US
Mailing Address - Phone:718-492-1467
Mailing Address - Fax:
Practice Address - Street 1:330 60TH ST
Practice Address - Street 2:ROOM 123
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3720
Practice Address - Country:US
Practice Address - Phone:718-492-1467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily