Healthcare Provider Details

I. General information

NPI: 1689379646
Provider Name (Legal Business Name): TINA THOMAS RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13656 BRETON RIDGE ST # AH
HOUSTON TX
77070-6081
US

IV. Provider business mailing address

13656 BRETON RIDGE ST # AH
HOUSTON TX
77070-6081
US

V. Phone/Fax

Practice location:
  • Phone: 281-429-8780
  • Fax:
Mailing address:
  • Phone: 281-429-8780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0300X
TaxonomyNephrology Registered Nurse
License Number835192
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: