Healthcare Provider Details

I. General information

NPI: 1669317830
Provider Name (Legal Business Name): TINA SANSOUCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 TOLL GATE RD
WARWICK RI
02886-2770
US

IV. Provider business mailing address

455 TOLL GATE RD
WARWICK RI
02886-2770
US

V. Phone/Fax

Practice location:
  • Phone: 401-921-7800
  • Fax:
Mailing address:
  • Phone: 401-921-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN69850
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: