Provider Demographics
NPI:1255106803
Name:KRUG, TINA RENEE (CNA)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:RENEE
Last Name:KRUG
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2666 N ALVERNON WAY APT B231
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1729
Mailing Address - Country:US
Mailing Address - Phone:520-302-9239
Mailing Address - Fax:
Practice Address - Street 1:2666 N ALVERNON WAY APT B231
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1729
Practice Address - Country:US
Practice Address - Phone:520-302-9239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty