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General NPI Number Information
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NPI Number | 1154331346
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Entity Type | Individual
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Provider Name | TINEY ELIZABETH RAY FNP
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Gender | Female
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 400 CONGRESS ST STE 300
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City | PORTLAND
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State | ME
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Zip | 04101-3553
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Country | US
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Telephone | 888-987-3991
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Fax | 888-502-6598
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Provider Business Mailing Address
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Address Line | 19 MERCER ST
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-6106
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Country | US
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Telephone | 845-216-9886
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Fax | 631-828-6869
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN229184
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 7456
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP161188
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License Number State | ME
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | CNP161188
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License Number State | ME
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN229184
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 101.0125069
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License Number State | VT
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Taxonomy #7
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 101.0125069
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License Number State | VT
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Taxonomy #8
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 7456
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License Number State | MN
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