Provider Demographics
NPI:1437366101
Name:FLAHERTY, TINA ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:ANN
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:TINA
Other - Middle Name:ANN
Other - Last Name:PELLEGRINO-FLAHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:450 BROOKLINE AVE
Mailing Address - Street 2:D1B30
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6013
Mailing Address - Country:US
Mailing Address - Phone:617-632-5082
Mailing Address - Fax:617-582-8608
Practice Address - Street 1:450 BROOKLINE AVE # D1B30
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5418
Practice Address - Country:US
Practice Address - Phone:617-632-5082
Practice Address - Fax:617-582-8608
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA191108363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care