Provider Demographics
NPI:1205811064
Name:HALLAUER, TINA DAWN (MA)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:DAWN
Last Name:HALLAUER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 W VINE ST
Mailing Address - Street 2:SUITE 266
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4643
Mailing Address - Country:US
Mailing Address - Phone:407-846-4111
Mailing Address - Fax:407-846-8088
Practice Address - Street 1:3501 W VINE ST
Practice Address - Street 2:SUITE 266
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4643
Practice Address - Country:US
Practice Address - Phone:407-846-4111
Practice Address - Fax:407-846-8088
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7530174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist