Provider Demographics
NPI:1205259090
Name:HAMILTON, TINA MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 W DR MLK BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6223
Mailing Address - Country:US
Mailing Address - Phone:813-872-7737
Mailing Address - Fax:813-443-8120
Practice Address - Street 1:3440 W DR MLK BLVD STE 203
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6223
Practice Address - Country:US
Practice Address - Phone:813-872-7737
Practice Address - Fax:813-443-8120
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9258016363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01497325OtherRAILROAD
FL010571600Medicaid
FLHR948YMedicare PIN