Provider Demographics
NPI:1841747722
Name:FIRLIE, TINA ANN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:ANN
Last Name:FIRLIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:ANN
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1940 ALCOA HWY STE E260
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-2266
Mailing Address - Country:US
Mailing Address - Phone:865-305-6955
Mailing Address - Fax:865-305-8238
Practice Address - Street 1:1940 ALCOA HWY STE E260
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-2266
Practice Address - Country:US
Practice Address - Phone:865-305-6955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC06212363A00000X
TN4590363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant