Provider Demographics
NPI:1700142403
Name:CLEARMAN, TINA D (APMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:D
Last Name:CLEARMAN
Suffix:
Gender:F
Credentials:APMHNP-BC
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 520
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MS
Mailing Address - Zip Code:39342-0520
Mailing Address - Country:US
Mailing Address - Phone:601-453-5376
Mailing Address - Fax:888-735-7202
Practice Address - Street 1:5003 POPLAR SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-1625
Practice Address - Country:US
Practice Address - Phone:601-453-5376
Practice Address - Fax:888-735-7202
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865852363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302I505113Medicare PIN