Provider Demographics
NPI:1346587409
Name:TIBERIO, TINA MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:TIBERIO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3158 WEST ST
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-4637
Mailing Address - Country:US
Mailing Address - Phone:304-797-7733
Mailing Address - Fax:304-797-7733
Practice Address - Street 1:200 LURAY DR
Practice Address - Street 2:
Practice Address - City:WINTERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3973
Practice Address - Country:US
Practice Address - Phone:304-797-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN269178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily