Provider Demographics
NPI:1912671496
Name:SHINAULT, TINA NICOLE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:NICOLE
Last Name:SHINAULT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11771
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-0771
Mailing Address - Country:US
Mailing Address - Phone:901-355-2813
Mailing Address - Fax:
Practice Address - Street 1:6400 SHELBY VIEW DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7659
Practice Address - Country:US
Practice Address - Phone:901-516-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000029740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily