Healthcare Provider Details

I. General information

NPI: 1972299030
Provider Name (Legal Business Name): TATIANA TORRES COSTA LINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST # 530
LITTLE ROCK AR
72205-7199
US

IV. Provider business mailing address

521 JACK STEPHENS DR
LITTLE ROCK AR
72205-5524
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-8820
  • Fax:
Mailing address:
  • Phone: 501-686-6560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-20787
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: