Healthcare Provider Details

I. General information

NPI: 1518079086
Provider Name (Legal Business Name): TINA R THROOP NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 BRADLEY ST
OWOSSO MI
48867-2552
US

IV. Provider business mailing address

633 APPLEGATE LN
GRAND BLANC MI
48439-1668
US

V. Phone/Fax

Practice location:
  • Phone: 989-729-4220
  • Fax: 989-729-4230
Mailing address:
  • Phone: 810-407-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704174012
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704174012
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: