Provider Demographics
NPI:1053795435
Name:CHAVIS, TINA S (FNP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:S
Last Name:CHAVIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:240 N TILLOTSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-3988
Mailing Address - Country:US
Mailing Address - Phone:765-288-1928
Mailing Address - Fax:765-741-0310
Practice Address - Street 1:2300 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1221
Practice Address - Country:US
Practice Address - Phone:765-939-2395
Practice Address - Fax:765-939-2425
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2021-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28184688A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28184688AOtherRN