Healthcare Provider Details

I. General information

NPI: 1750319711
Provider Name (Legal Business Name): TINA P BEISSINGER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 EAST DESOTO STREET
PENSACOLA FL
32501-3337
US

IV. Provider business mailing address

1221 EAST DESOTO STREET
PENSACOLA FL
32501-3337
US

V. Phone/Fax

Practice location:
  • Phone: 850-437-9997
  • Fax: 850-439-2122
Mailing address:
  • Phone: 850-437-9997
  • Fax: 850-439-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY0003056
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: