Provider Demographics
NPI:1467048363
Name:TUNE, NICHOLE PACIFICO (CRNP)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:PACIFICO
Last Name:TUNE
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 1:821 DE FRANCEAUX HBR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-6519
Mailing Address - Country:US
Mailing Address - Phone:443-703-9117
Mailing Address - Fax:
Practice Address - Street 1:1235 E MONUMENT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-5327
Practice Address - Country:US
Practice Address - Phone:410-327-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR206948363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics