Healthcare Provider Details

I. General information

NPI: 1679944144
Provider Name (Legal Business Name): TINA SUZANNE MORRIS MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W HOUSTON ST
JASPER TX
75951-4013
US

IV. Provider business mailing address

635 DRAWHORN RD
BRONSON TX
75930-5304
US

V. Phone/Fax

Practice location:
  • Phone: 409-384-3430
  • Fax:
Mailing address:
  • Phone: 936-275-8681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP129284
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: