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NPI Code Detail

MEDICARE: MRS. TINA MARY ANAT LPN

MEDICARE: MRS. TINA MARY ANAT LPN
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
1164W00000XLicensed Practical NurseLPN12192NV

General Provider Information

NPI Number : 1689374225
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TINA MARY ANAT LPN
Provider Business Mailing Address
First Line : 3890 LILAC HAZE ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-6857
Country : US
Telephone Number : 702-610-6241
Fax Number :
Provider Business Practice Location Address
First Line : 3890 LILAC HAZE ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-6857
Country : US
Telephone Number : 702-610-6241
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2023
Last Update Date : 03/02/2023

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