Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2020-04516 | NC |
N | 207Q00000X | Family Doctor | 43965 | TN |
N | 207QS0010X | Family Doctor - Sports Medicine | 43965 | TN |
NPI | 1053430462 |
---|---|
Provider Name | Dr. Tanika M. Pinn |
First Address | Kinston, NC 28502-2278 |
Second Address | Columbia, TN 38401-1810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103I089193 | MEDICARE (01) | TN |
1518287 | (05) | TN |
3710144 | GROUP - MEDICARE (01) | TN |