Provider Demographics
NPI:1477919751
Name:SARY, TINA (NP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:SARY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 MUNDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-2708
Mailing Address - Country:US
Mailing Address - Phone:949-357-4788
Mailing Address - Fax:
Practice Address - Street 1:4714 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-2247
Practice Address - Country:US
Practice Address - Phone:757-380-8709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-03
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA813028163W00000X
VA0024173233363LF0000X
CA95005392363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse