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General NPI Number Information
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NPI Number | 1710968300
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Entity Type | Individual
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Provider Name | TINA ANNETTE CONNALLY RN
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Gender | Female
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Dates
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Enumeration Date | 11/10/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | HHC, 121ST GENERAL HOSPITAL ATTN: DON/ICU
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City | APO
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State | AP
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Zip | 96205
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Country | KR
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Telephone | 01182279175068
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Fax | 01182279173000
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Provider Business Mailing Address
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Address Line | 18TH MEDCOM ATTN: DCCS-QM (CREDENTIALS)
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City | APO
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State | AP
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Zip | 96205-0054
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Country | KR
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Telephone | 01182279166027
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Fax | 01182279178110
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R28975
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License Number State | NM
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