Healthcare Provider Details

I. General information

NPI: 1407297633
Provider Name (Legal Business Name): TINA MARIE ROUTE MSN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 COLONIAL DR
TOWANDA PA
18848-8107
US

IV. Provider business mailing address

2476 SYLVANIA RD
TROY PA
16947-9603
US

V. Phone/Fax

Practice location:
  • Phone: 570-265-6165
  • Fax: 570-265-3616
Mailing address:
  • Phone: 607-857-2589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSPO14286
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number542682-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN550586
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: