Healthcare Provider Details

I. General information

NPI: 1508215435
Provider Name (Legal Business Name): TINA VIOLETTA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 S MADISON DR
TEMPE AZ
85281-7248
US

IV. Provider business mailing address

1710 W ARGON ST
MESA AZ
85201-6111
US

V. Phone/Fax

Practice location:
  • Phone: 480-784-1514
  • Fax:
Mailing address:
  • Phone: 480-290-1837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP8751
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: