Provider Demographics
NPI:1932359312
Name:GRIMES, TINA L (CRNA)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:L
Last Name:GRIMES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 FM 879
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:TX
Mailing Address - Zip Code:75152-8214
Mailing Address - Country:US
Mailing Address - Phone:903-724-4480
Mailing Address - Fax:903-724-4480
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-648-9374
Practice Address - Fax:214-648-5461
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX620214367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered