MEDICARE: MISS TINA MICHELLE GABBARD APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SM0705X	Medical-Surgical Clinical Nurse Specialist	S01071	AR

General Provider Information

NPI Number	:	1346202215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TINA MICHELLE GABBARD APN

Provider Business Mailing Address
First Line	:	4300 W 7TH ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-5446
Country	:	US
Telephone Number	:	501-257-6850
Fax Number	:	501-257-6810

Provider Business Practice Location Address
First Line	:	4300 W 7TH ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-5446
Country	:	US
Telephone Number	:	501-257-6850
Fax Number	:	501-257-6810

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	07/26/2007

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