Provider Demographics
NPI:1669145645
Name:STATON, TINA MARIE
Entity type:Individual
Prefix:MISS
First Name:TINA
Middle Name:MARIE
Last Name:STATON
Suffix:
Gender:F
Credentials:
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 231
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:NC
Mailing Address - Zip Code:27812-0231
Mailing Address - Country:US
Mailing Address - Phone:252-917-7792
Mailing Address - Fax:
Practice Address - Street 1:3632 SMITH ST
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:NC
Practice Address - Zip Code:27812-0000
Practice Address - Country:US
Practice Address - Phone:252-917-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)