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Contact Information

TINA J SOUTHWARD, PAC
75 UNIVERISTY BLVD
STE 130
ROSWELL, NM88203
 Phone: 575-624-7207
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Medical

363AM0700X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for TINA J SOUTHWARD · (Female)

NPI Number 1164434387
Status Active
Credentials PAC
Entity Individual
Enumeration date 08/13/2006
Last updated 07/12/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • NM License # 95-PA10
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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