Provider Demographics
NPI:1720428188
Name:HILL, TINA LATISHA
Entity Type:Individual
Prefix:
First Name:TINA LATISHA
Middle Name:
Last Name:HILL
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:UNIT 27528
Mailing Address - Street 2:UNIT 27528 CMR 459
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09139-7528
Mailing Address - Country:US
Mailing Address - Phone:0951-300-7772
Mailing Address - Fax:
Practice Address - Street 1:UNIT 27528
Practice Address - Street 2:USAHC- BAMBERG UNIT 27528 CMR 459
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09139-7528
Practice Address - Country:US
Practice Address - Phone:0951-300-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA175760163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health