Healthcare Provider Details

I. General information

NPI: 1174586119
Provider Name (Legal Business Name): TINA HAWLEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 YORK ST
CORRY PA
16407-1420
US

IV. Provider business mailing address

300 YORK ST
CORRY PA
16407-1420
US

V. Phone/Fax

Practice location:
  • Phone: 814-665-8288
  • Fax: 814-664-8618
Mailing address:
  • Phone: 814-665-8288
  • Fax: 814-664-8618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP004410B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: