Provider Demographics
NPI:1467126565
Name:TINOCO, BUKET (FNP-C)
Entity Type:Individual
Prefix:
First Name:BUKET
Middle Name:
Last Name:TINOCO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4795 ALLISON DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-6261
Mailing Address - Country:US
Mailing Address - Phone:770-330-6225
Mailing Address - Fax:
Practice Address - Street 1:555 SUN VALLEY DR UNIT C-1
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:404-907-3982
Practice Address - Fax:678-775-8877
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN268917363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily