Active NPI
Tina Luanne Green, FNP-BC
- Family Nurse Practitioner
- Gaffney, SC
National Provider Identifier
1013476506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 21930
- Practice address
- 104 Willis PLZ
Gaffney, SC 29341-1500 - Phone
- (800) 792-9030
- NPI assigned
- Mar 14, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 21930 | SC | Primary |
Addresses
Primary practice location
104 Willis PLZ
Gaffney, SC 29341-1500
Mailing address
656 Sloan Rd
Lyman, SC 29365-9509
Phone (864) 580-8000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21930 | Other | SC | OFFICE DOES NOT ACCEPT INSURANCE, MEDICARE OR MEDICAID. |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21930 | SC | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552521600000",
"number": "1013476506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "656 SLOAN RD",
"city": "LYMAN",
"state": "SC",
"postal_code": "293659509",
"telephone_number": "864-580-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 WILLIS PLZ",
"city": "GAFFNEY",
"state": "SC",
"postal_code": "293411500",
"telephone_number": "800-792-9030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "TINA",
"middle_name": "LUANNE",
"credential": "FNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-14",
"last_updated": "2019-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "SC",
"license": "21930",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OFFICE DOES NOT ACCEPT INSURANCE, MEDICARE OR MEDICAID.",
"identifier": "21930",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gaffney, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.