Provider Demographics
NPI:1043704349
Name:MOND, TINA TERESA (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:TERESA
Last Name:MOND
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N 8TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62201-2989
Mailing Address - Country:US
Mailing Address - Phone:618-274-9105
Mailing Address - Fax:618-274-9101
Practice Address - Street 1:100 N 8TH ST STE 120
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62201-2989
Practice Address - Country:US
Practice Address - Phone:618-274-9105
Practice Address - Fax:618-274-9101
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018258363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily