Provider Demographics
NPI:1780744037
Name:POINDEXTER, TINA LOUISE (FNP-C)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:LOUISE
Last Name:POINDEXTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 BECKER COLONY DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-3949
Mailing Address - Country:US
Mailing Address - Phone:404-509-9947
Mailing Address - Fax:
Practice Address - Street 1:503 BECKER COLONY DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-3949
Practice Address - Country:US
Practice Address - Phone:404-509-9947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN154259NP363LF0000X
OR201502279NP-PP363LF0000X
NC5010707363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBKZGMedicare UPIN