Provider Demographics
NPI:1245732965
Name:FLORA, TINA (PCA)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:
Last Name:FLORA
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 HARMON'S BRANCH
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213
Mailing Address - Country:US
Mailing Address - Phone:304-741-4087
Mailing Address - Fax:
Practice Address - Street 1:461 HARMON'S BRANCH
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:WV
Practice Address - Zip Code:25213
Practice Address - Country:US
Practice Address - Phone:304-741-4087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
G2003256000OtherPROVIDER ID