Healthcare Provider Details

I. General information

NPI: 1528275633
Provider Name (Legal Business Name): TINA M MCGINTY CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 09/27/2020
Certification Date: 09/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 CHURCH AVE
GULFPORT MS
39507-1255
US

IV. Provider business mailing address

250 CHURCH AVE
GULFPORT MS
39507-1255
US

V. Phone/Fax

Practice location:
  • Phone: 228-224-5264
  • Fax: 228-897-1100
Mailing address:
  • Phone: 228-224-5264
  • Fax: 228-897-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number97253
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: