Healthcare Provider Details

I. General information

NPI: 1417227745
Provider Name (Legal Business Name): TINA MARIE OVERSTREET BA, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TINA MARIE GARCIA BA, PA-C

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3152 N MILLBROOK AVE
FRESNO CA
93703-1400
US

IV. Provider business mailing address

1792 N DEWITT AVE
CLOVIS CA
93619-7516
US

V. Phone/Fax

Practice location:
  • Phone: 559-244-0133
  • Fax:
Mailing address:
  • Phone: 559-905-1661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1099313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: