Healthcare Provider Details

I. General information

NPI: 1548907272
Provider Name (Legal Business Name): TINA CRANE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2022
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 90 BOX 12580 #1
GRAND BAY AL
36541
US

IV. Provider business mailing address

2122 INGALLS AVE
PASCAGOULA MS
39567-5844
US

V. Phone/Fax

Practice location:
  • Phone: 251-454-4751
  • Fax: 251-202-6899
Mailing address:
  • Phone: 251-454-4751
  • Fax: 251-202-6899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number905293
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: