Provider Demographics
NPI:1457918138
Name:ADAMS, TINA CHRISTINE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:CHRISTINE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 551296
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32255-1296
Mailing Address - Country:US
Mailing Address - Phone:314-575-8587
Mailing Address - Fax:
Practice Address - Street 1:5000 BIG ISLAND DR UNIT 306
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-5336
Practice Address - Country:US
Practice Address - Phone:314-575-8587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9323305163W00000X
FL11010624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse