Provider Demographics
NPI:1346493871
Name:MURPHY, TINA M (APRN, CNP)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:MURPHY
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 WEST AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4508
Mailing Address - Country:US
Mailing Address - Phone:708-590-5304
Mailing Address - Fax:708-590-5308
Practice Address - Street 1:15300 WEST AVE STE 120
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4508
Practice Address - Country:US
Practice Address - Phone:708-590-5304
Practice Address - Fax:708-590-5308
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000431363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid