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General NPI Number Information
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NPI Number | 1285120196
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Entity Type | Individual
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Provider Name | TINA MARIE WATERS CRNP
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Gender | Female
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Dates
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Enumeration Date | 07/03/2018
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 446 N READING RD
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City | EPHRATA
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State | PA
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Zip | 17522-9802
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Country | US
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Telephone | 717-738-4334
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Fax | 717-738-3289
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Provider Business Mailing Address
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Address Line | 3421 CONCORD RD
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City | YORK
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State | PA
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Zip | 17402-9001
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Country | US
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Telephone | 717-738-4334
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Fax | 717-738-3289
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP018950
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License Number State | PA
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