MEDICARE: TINA MARIE GARLAND

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	171M00000X	Case Manager/Care Coordinator	019629325	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17	OTHER	NM	17

General Provider Information

NPI Number	:	1689909590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA MARIE GARLAND

Provider Business Mailing Address
First Line	:	PO BOX 3157
Second Line	:
City	:	ESPANOLA
State	:	NM
Zip	:	87533-3157
Country	:	US
Telephone Number	:	505-747-1991
Fax Number	:	505-753-6462

Provider Business Practice Location Address
First Line	:	904 E FAIRVIEW LN
Second Line	:
City	:	ESPANOLA
State	:	NM
Zip	:	87532-2822
Country	:	US
Telephone Number	:	505-747-1991
Fax Number	:	505-753-6462

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

Provider Enumeration Date	:	10/09/2009
Last Update Date	:	10/09/2009

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Directions to “ TINA MARIE GARLAND ” Practice Location

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