Provider Demographics
NPI:1578744827
Name:SANTOPOALO, TINA ELISE (MSN)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:ELISE
Last Name:SANTOPOALO
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 FLOSSMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2539
Mailing Address - Country:US
Mailing Address - Phone:847-662-5184
Mailing Address - Fax:
Practice Address - Street 1:1031 FLOSSMOOR AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2539
Practice Address - Country:US
Practice Address - Phone:847-662-5184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse