Healthcare Provider Details

I. General information

NPI: 1902575681
Provider Name (Legal Business Name): TINESHA RENEE RHODES CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 01/28/2024
Certification Date: 01/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 NASON DR
ROARING SPRING PA
16673-1202
US

IV. Provider business mailing address

17285 LITTLE VALLEY RD
SAXTON PA
16678-7962
US

V. Phone/Fax

Practice location:
  • Phone: 814-224-2141
  • Fax:
Mailing address:
  • Phone: 814-506-7868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP023975
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: