1710968300 NPI number — MRS. TINA ANNETTE CONNALLY RN

Table of content: MRS. TINA ANNETTE CONNALLY RN (NPI 1710968300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710968300 NPI number — MRS. TINA ANNETTE CONNALLY RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONNALLY
Provider First Name:
TINA
Provider Middle Name:
ANNETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
TINA
Provider Other Middle Name:
ANNETTE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710968300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18TH MEDCOM
Provider Second Line Business Mailing Address:
ATTN: DCCS-QM (CREDENTIALS)
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96205-0054
Provider Business Mailing Address Country Code:
KR
Provider Business Mailing Address Telephone Number:
01182279166027
Provider Business Mailing Address Fax Number:
01182279178110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HHC, 121ST GENERAL HOSPITAL
Provider Second Line Business Practice Location Address:
ATTN: DON/ICU
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96205
Provider Business Practice Location Address Country Code:
KR
Provider Business Practice Location Address Telephone Number:
01182279175068
Provider Business Practice Location Address Fax Number:
01182279173000
Provider Enumeration Date:
11/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  R28975 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com