Provider Demographics
NPI:1881935476
Name:CRABTREE, TINA MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:CRABTREE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N POST RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-3605
Mailing Address - Country:US
Mailing Address - Phone:405-455-4342
Mailing Address - Fax:405-455-4381
Practice Address - Street 1:111 N POST RD
Practice Address - Street 2:SUITE C
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-3605
Practice Address - Country:US
Practice Address - Phone:405-455-4342
Practice Address - Fax:405-455-4381
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK86078363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health