Healthcare Provider Details

I. General information

NPI: 1558040725
Provider Name (Legal Business Name): TINA DUNLAP FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050A 2ND ST SE
KIRTLAND AFB NM
87117-5901
US

IV. Provider business mailing address

221 3RD ST W
RANDOLPH AFB TX
78150-4800
US

V. Phone/Fax

Practice location:
  • Phone: 505-846-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1128464
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: