Provider Demographics
NPI:1336377134
Name:BOYERS, TINA CAROL (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:CAROL
Last Name:BOYERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-9154
Mailing Address - Country:US
Mailing Address - Phone:941-737-6755
Mailing Address - Fax:
Practice Address - Street 1:1176 MILL CREEK RD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-9154
Practice Address - Country:US
Practice Address - Phone:941-737-6755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5154935164W00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide