Individual
MRS. TINA L PURCELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-3850
(508) 334-5623
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2642
MA
363AS0400X
Surgical Physician Assistant
PA00594
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110110949A
—
MA
Enumeration date
11/25/2008
Last updated
06/01/2021
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