Provider Demographics
NPI:1578000550
Name:TOLENTINO, MARY GRACE M (NP-C)
Entity Type:Individual
Prefix:MISS
First Name:MARY GRACE
Middle Name:M
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 TILDEN AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1846
Mailing Address - Country:US
Mailing Address - Phone:201-982-1227
Mailing Address - Fax:
Practice Address - Street 1:618 TILDEN AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1846
Practice Address - Country:US
Practice Address - Phone:201-982-1227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00704900363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care