Healthcare Provider Details

I. General information

NPI: 1629078829
Provider Name (Legal Business Name): TINA NADINE HOOVER ADULT NURSE PRACTITI
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E FLORENCE BLVD STE. H
CASA GRANDE AZ
85222-4666
US

IV. Provider business mailing address

609 E MANOR DR
CASA GRANDE AZ
85222-2614
US

V. Phone/Fax

Practice location:
  • Phone: 520-836-4382
  • Fax: 520-876-5794
Mailing address:
  • Phone: 520-423-1954
  • Fax: 520-876-5794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN022497
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: