Provider Demographics
NPI:1790191369
Name:RIGGS, TINA (ANP-C, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:RIGGS
Suffix:
Gender:F
Credentials:ANP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 NESCONSET HWY STE 208B
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1154
Mailing Address - Country:US
Mailing Address - Phone:631-662-6655
Mailing Address - Fax:631-689-3993
Practice Address - Street 1:1227 MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2227
Practice Address - Country:US
Practice Address - Phone:631-833-8109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF405096-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF405096-01OtherPSYCHIATRY