Provider Demographics
NPI:1720019185
Name:ADAMS, TINA MARIE (RPA-C)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:REINHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:1555 LONG POND RD
Mailing Address - Street 2:DEPT OF SURGERY
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-723-7281
Mailing Address - Fax:585-723-8660
Practice Address - Street 1:1555 LONG POND RD
Practice Address - Street 2:DEPT OF SURGERY
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-723-7281
Practice Address - Fax:585-723-8660
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009404363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA0596-GRPBA0017Medicare PIN
PA0597Medicare ID - Type Unspecified
P019009404OtherEXCELLUS
000925955001OtherHEALTHNOW
153741FLOtherPREFERRED CARE
PA0596Medicare ID - Type Unspecified