Healthcare Provider Details

I. General information

NPI: 1023240587
Provider Name (Legal Business Name): TINA M. DAVIS-LARKIN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

8043 S FAIRFIELD AVE
CHICAGO IL
60652-2717
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-4116
  • Fax: 708-684-4272
Mailing address:
  • Phone: 708-684-4116
  • Fax: 708-684-4272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number209006718
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number209006718
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: