Provider Demographics
NPI:1932152303
Name:CAIAZZO, TINA (PA-C/ATC09/)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:CAIAZZO
Suffix:
Gender:F
Credentials:PA-C/ATC09/
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 837
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-0837
Mailing Address - Country:US
Mailing Address - Phone:845-926-2421
Mailing Address - Fax:
Practice Address - Street 1:US ARMY/SCHOFIELD BARRACKS
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:HI
Practice Address - Zip Code:96787
Practice Address - Country:US
Practice Address - Phone:808-433-8626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010066-1363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical