Provider Demographics
NPI:1912163510
Name:STANLEY, TINA MARIE (RT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103B EGRET LANDING CT
Mailing Address - Street 2:
Mailing Address - City:SURF CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28445-9410
Mailing Address - Country:US
Mailing Address - Phone:858-254-3330
Mailing Address - Fax:
Practice Address - Street 1:103B EGRET LANDING CT
Practice Address - Street 2:
Practice Address - City:SURF CITY
Practice Address - State:NC
Practice Address - Zip Code:28445-9410
Practice Address - Country:US
Practice Address - Phone:858-254-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-03
Last Update Date:2008-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411530247100000X, 2471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist