Provider Demographics
NPI:1821599960
Name:WHEAT, TINA LYN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:LYN
Last Name:WHEAT
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9503 SEKULA DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-6912
Mailing Address - Country:US
Mailing Address - Phone:210-832-2576
Mailing Address - Fax:
Practice Address - Street 1:9503 SEKULA DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-6912
Practice Address - Country:US
Practice Address - Phone:210-832-2576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX844884163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse