Provider Demographics
NPI:1427010933
Name:TINO, ELAINE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:
Last Name:TINO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ASH LN
Mailing Address - Street 2:
Mailing Address - City:DRUMS
Mailing Address - State:PA
Mailing Address - Zip Code:18222-2003
Mailing Address - Country:US
Mailing Address - Phone:570-788-4605
Mailing Address - Fax:
Practice Address - Street 1:1730 E BROAD ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5622
Practice Address - Country:US
Practice Address - Phone:570-455-9589
Practice Address - Fax:570-455-8848
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP007000B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily