Individual
TIA CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSFA
Contact information
Practice address
4415 GANNON RD, PORTSMOUTH, VA 23703-4830
(814) 590-3812
Mailing address
4415 GANNON RD, PORTSMOUTH, VA 23703-4830
(814) 590-3812
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
0136000424
VA
Other
Enumeration date
12/24/2024
Last updated
12/24/2024
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