Provider Demographics
NPI:1841624012
Name:MOBLEY, TINA LYNNE (APRN)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:LYNNE
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:LYNNE
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 MARKET ST UNIT 222
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-8804
Mailing Address - Country:US
Mailing Address - Phone:904-701-1800
Mailing Address - Fax:
Practice Address - Street 1:701 MARKET ST STE 111
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8803
Practice Address - Country:US
Practice Address - Phone:904-701-1800
Practice Address - Fax:904-701-1888
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9222851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHW497ZMedicare PIN