MEDICARE: TINA JOY APRN-CNP, FNP-BC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	77055	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	77055	OTHER	OK	APRN-CNP
2	2015022832	OTHER	OK	ANCC

General Provider Information

NPI Number	:	1821515032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TINA JOY APRN-CNP, FNP-BC, LLC

Provider Business Mailing Address
First Line	:	3431 S BOULEVARD STE 109
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-5514
Country	:	US
Telephone Number	:	405-562-1870
Fax Number	:	405-562-1871

Provider Business Practice Location Address
First Line	:	3431 S BOULEVARD STE 109
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-5514
Country	:	US
Telephone Number	:	405-562-1870
Fax Number	:	405-562-1871

Authorized Official
Title or Position	:	FAMILY NURSE PRACTITIONER, PROVIDER
Name	:	MRS. TINA GAY JOY
Credential	:	APRN-CNP
Telephone Number	:	405-312-2775

Provider Enumeration Date	:	08/28/2017
Last Update Date	:	07/21/2022

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