Provider Demographics
NPI:1649838129
Name:CRENTSIL, TINA M (RN)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:CRENTSIL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MAAME
Other - Middle Name:A
Other - Last Name:ESSOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 HARLEY DR APT 4
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-1740
Mailing Address - Country:US
Mailing Address - Phone:949-232-3015
Mailing Address - Fax:
Practice Address - Street 1:39 SCENIC AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-3427
Practice Address - Country:US
Practice Address - Phone:949-232-3015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2323091163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse