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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Sunday, December 8, 2024 6:44 PM CST
Next Update: Monday, December 9, 2024 2:50 AM CST

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JOHNSON, TINA DIANE       
This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
Practice Address: ROBERT M. GREER CENTER/LIBERTY HEALTHCARE
2501 DELAWARE
ENID OK 73701

Address last updated on 11/1/2023
Phone #: (580) 213-2700
Fax #:
County: OKLAHOMA
License: 229
Dated: 8/27/2020
Expires: 11/30/2025
Temp. Ltr. Issued: 7/2/2020
Temp. Ltr. Expires: 9/10/2020
License Type: Therapeutic Recreation Specialist
Specialty:
Status: Active
Status Class: Fully Licensed
Restricted to:
CME Year: 0
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Locations: Hours: Languages:
ROBERT M. GREER CENTER/LIBERTY HEALTHCARE
2501 DELAWARE
ENID OK 73701

Phone #: (580) 213-2700
Fax #:
Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
JULIE KAY COSTILLA TRS 61

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