=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740631217
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TINA M SOSBY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2016
-----------------------------------------------------
Last Update Date | 08/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 805 E PIKE ST
-----------------------------------------------------
City | JACKSON CENTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45334-6001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-596-0456
-----------------------------------------------------
Fax | 937-596-0462
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 805 E PIKE ST P.O. BOX 626
-----------------------------------------------------
City | JACKSON CENTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45334-6001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-596-0456
-----------------------------------------------------
Fax | 937-596-0462
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.019633
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------