Healthcare Provider Details

I. General information

NPI: 1487560876
Provider Name (Legal Business Name): TINA LATURNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E TULLY ST
CONVOY OH
45832-8876
US

IV. Provider business mailing address

510 E TULLY ST
CONVOY OH
45832-8876
US

V. Phone/Fax

Practice location:
  • Phone: 419-749-9100
  • Fax: 419-749-2195
Mailing address:
  • Phone: 419-749-9100
  • Fax: 419-749-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number347609
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: