Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tina Hall

Individual provider Family Nurse Practitioner · NPI 1578039707

Tina Hall is a Nurse Practitioner in Mount Vernon, Illinois. Qualified in 2018, 8 years ago. Practices with Divani Dermatology LLC, a 13-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
8
Licensed in
IL
In the registry since
2018
Specialties on file
4
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

4107 S Water Tower Pl
Mount Vernon, IL 62864-6293
Phone: (618) 244-0031
Fax: (618) 244-0056
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 209.018461 (IL)
Registered Nurse Taxonomy 163W00000X · Licence 041.394076 (IL)
Dermatology Physician Taxonomy 207N00000X · Licence 209018461 (IL)
Nurse Practitioner Taxonomy 363L00000X · Licence 209018461 (IL)

Record details

NPI number1578039707
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedOctober 15, 2018
Last updated in NPPESNovember 7, 2019
Mailing address2253 N Flamingo Ln, Scheller, IL 62883-3009

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Divani Dermatology Llc — 13 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Mount Vernon