Provider Demographics
NPI:1750958880
Name:VARGAS, TINA M (MSW, RCSWI)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:M
Last Name:VARGAS
Suffix:
Gender:F
Credentials:MSW, RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 GIRVAN DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-7878
Mailing Address - Country:US
Mailing Address - Phone:813-317-5252
Mailing Address - Fax:
Practice Address - Street 1:7906 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-7036
Practice Address - Country:US
Practice Address - Phone:727-753-9442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW158541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical