Healthcare Provider Details

I. General information

NPI: 1689716565
Provider Name (Legal Business Name): TINA JOYCE DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8007 AUBURN RD SUITE 3
PAINESVILLE OH
44077-9600
US

IV. Provider business mailing address

8007 AUBURN RD SUITE 3
PAINESVILLE OH
44077-9600
US

V. Phone/Fax

Practice location:
  • Phone: 440-375-5520
  • Fax: 440-375-5520
Mailing address:
  • Phone: 440-375-5520
  • Fax: 440-350-0955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-008375
License Number StateOH

VIII. Authorized Official

Name: DR. TINA MARIE TRZASKA JOYCE
Title or Position: PRESIDENT
Credential: DO
Phone: 440-375-5520