Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 683975 | TX |
NPI | 1023354693 |
---|---|
Provider Name | Anitha Tinu |
First Address | Irving, TX 75063-4415 |
Second Address | Arlington, TX 76015-2911 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2012 |
Last Update Date | 29/12/2012 |