Provider Demographics
NPI:1184968257
Name:KINCAID, TINA (LMT CLE)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:KINCAID
Suffix:
Gender:F
Credentials:LMT CLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 SE 17TH STREET SUITE 401
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471
Mailing Address - Country:US
Mailing Address - Phone:352-789-6026
Mailing Address - Fax:
Practice Address - Street 1:2405 SE 17TH ST STE 401
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-2608
Practice Address - Country:US
Practice Address - Phone:352-789-6026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA69776174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist