Provider Demographics
NPI:1649691288
Name:GOWAN, TINA (CSFA)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:GOWAN
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6324 N CAMINO HERMOSILLO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-3533
Mailing Address - Country:US
Mailing Address - Phone:520-450-0461
Mailing Address - Fax:
Practice Address - Street 1:6324 N CAMINO HERMOSILLO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-3533
Practice Address - Country:US
Practice Address - Phone:520-450-0461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-29
Last Update Date:2013-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant