Healthcare Provider Details

I. General information

NPI: 1306035605
Provider Name (Legal Business Name): TINA MARIE SWEENEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TINA MARIE TAYLOR RN

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3204 PINE VALLEY RD
COLUMBUS OH
43219-1647
US

IV. Provider business mailing address

3204 PINE VALLEY RD
COLUMBUS OH
43219-1647
US

V. Phone/Fax

Practice location:
  • Phone: 614-747-4686
  • Fax:
Mailing address:
  • Phone: 614-477-7407
  • Fax: 186-699-9120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number025623
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 269455
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: