Provider Demographics
NPI:1881891265
Name:MCGREW, TINA FLEMING (CFNP)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:FLEMING
Last Name:MCGREW
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12506 OAK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-5710
Mailing Address - Country:US
Mailing Address - Phone:228-831-2512
Mailing Address - Fax:228-436-9845
Practice Address - Street 1:321-B DIVISON STREET
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530
Practice Address - Country:US
Practice Address - Phone:228-436-8886
Practice Address - Fax:228-436-9845
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR852474363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily