Healthcare Provider Details

I. General information

NPI: 1346688488
Provider Name (Legal Business Name): TINA M TODD NP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 E CHERRY CIR
MEMPHIS TN
38117-3522
US

IV. Provider business mailing address

PO BOX 770118
MEMPHIS TN
38177-0118
US

V. Phone/Fax

Practice location:
  • Phone: 901-859-4321
  • Fax:
Mailing address:
  • Phone: 901-821-0338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TINA M TODD
Title or Position: SOLE OWNER
Credential: NP
Phone: 901-683-5436