Healthcare Provider Details

I. General information

NPI: 1194151423
Provider Name (Legal Business Name): TINA GAYLE HANNER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 05/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 W COKE RD BLDG. 4, STE 6
WINNSBORO TX
75494-3011
US

IV. Provider business mailing address

PO BOX 846098
DALLAS TX
75284-6098
US

V. Phone/Fax

Practice location:
  • Phone: 903-342-3760
  • Fax:
Mailing address:
  • Phone: 903-324-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number661717
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: