Individual ProviderTina HaitzRegistered NurseNursing Service ProvidersPractice Address1203 Powder River Trl, Southlake, TX 76092-3232(817) 368-7345PECOS EnrollmentBased on the most recent information from CMS, provider Tina Haitz does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:15 AM.Profile DetailsProvider ID1922617422Provider TypeIndividualFull NameHaitz, TinaGenderFemaleSole ProprietorNoEnumeration Date7/30/2020Last Updated7/30/2020Contact InformationPractice LocationPractice Address1203 Powder River Trl, Southlake, TX 76092-3232Phone(817) 368-7345FaxUnlisted FaxMailing LocationMailing Address1203 Powder River Trl, Southlake, TX 76092-3232Phone(817) 368-7345FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode163W00000XPrimaryDescriptionRegistered NurseNursing Service ProvidersLicense626419Texas