Provider Demographics
NPI:1023192770
Name:PUCINO, TAMI L (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:L
Last Name:PUCINO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:L
Other - Last Name:BERGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:3548 US HIGHWAY 9W
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1700
Mailing Address - Country:US
Mailing Address - Phone:845-541-9840
Mailing Address - Fax:323-375-3799
Practice Address - Street 1:3548 US HIGHWAY 9W
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528
Practice Address - Country:US
Practice Address - Phone:845-541-9840
Practice Address - Fax:323-375-3799
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334835363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03017287Medicaid