Provider Demographics
NPI:1811160062
Name:TINKIS, GWEN (NP)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:TINKIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 TIMBERLINE DR S
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-3508
Mailing Address - Country:US
Mailing Address - Phone:817-329-8364
Mailing Address - Fax:817-329-1285
Practice Address - Street 1:1050 E HWY 114
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-5242
Practice Address - Country:US
Practice Address - Phone:817-329-8364
Practice Address - Fax:817-329-1285
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX571839363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX571839OtherNP