Provider Demographics
NPI:1720619158
Name:MCKINNIE, TINA M (RN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:MCKINNIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19981 ROAD 18R
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45830-9254
Mailing Address - Country:US
Mailing Address - Phone:419-234-0351
Mailing Address - Fax:
Practice Address - Street 1:19981 ROAD 18R
Practice Address - Street 2:
Practice Address - City:COLUMBUS GROVE
Practice Address - State:OH
Practice Address - Zip Code:45830-9254
Practice Address - Country:US
Practice Address - Phone:419-234-0351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.171087163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse