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General NPI Number Information
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NPI Number | 1811813603
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Entity Type | Individual
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Provider Name | TINA CANTRELL PMHNP
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Gender | Female
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Dates
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Enumeration Date | 06/25/2026
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Last Update Date | 06/25/2026
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Provider Practice Location Address
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Address Line | 8180 REGENT PKWY STE 109
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City | FORT MILL
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State | SC
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Zip | 29715-8417
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Country | US
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Telephone | 803-979-6171
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Fax |
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Provider Business Mailing Address
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Address Line | 317 BLUE SKY DR NW
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City | CONCORD
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State | NC
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Zip | 28027-7344
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Country | US
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Telephone |
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Fax |
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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 | 5024728
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License Number State | NC
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