MEDICARE: MRS. TINA MARIE JONES FNP

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	363LF0000X	Family Nurse Practitioner	129376	TN
2	363LF0000X	Family Nurse Practitioner	8128	TN

General Provider Information

NPI Number	:	1568501096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TINA MARIE JONES FNP

Provider Business Mailing Address
First Line	:	6820 OLD BRIDGE LN
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-2661
Country	:	US
Telephone Number	:	18-498-4409
Fax Number	:	901-565-8787

Provider Business Practice Location Address
First Line	:	3725 CHAMPION HILLS DR
Second Line	:	SUITE 2000
City	:	MEMPHIS
State	:	TN
Zip	:	38125-2597
Country	:	US
Telephone Number	:	901-367-9001
Fax Number	:	901-565-8787

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	12/01/2023

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