Healthcare Provider Details

I. General information

NPI: 1508921388
Provider Name (Legal Business Name): TINA MARCIA ALMANZA PPCNP-BC, MSN, AE-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 WILKINS ST
DETROIT MI
48207-2112
US

IV. Provider business mailing address

230 E BOSTON BLVD
DETROIT MI
48202-1321
US

V. Phone/Fax

Practice location:
  • Phone: 313-833-1100
  • Fax: 313-832-5531
Mailing address:
  • Phone: 313-287-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberTA151924
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: