Provider Demographics
NPI:1932335908
Name:HEAD, TINA M (BS)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:M
Last Name:HEAD
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:WORRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:1714 HIGHWAY 93
Mailing Address - Street 2:SUITE 11
Mailing Address - City:FALL BRANCH
Mailing Address - State:TN
Mailing Address - Zip Code:37656-1763
Mailing Address - Country:US
Mailing Address - Phone:423-348-6101
Mailing Address - Fax:423-348-6716
Practice Address - Street 1:1714 HIGHWAY 93
Practice Address - Street 2:SUITE 11
Practice Address - City:FALL BRANCH
Practice Address - State:TN
Practice Address - Zip Code:37656-1763
Practice Address - Country:US
Practice Address - Phone:423-348-6101
Practice Address - Fax:423-348-6716
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist