Provider Demographics
NPI:1588834527
Name:CUPERTINO, TANNIA (MSN, RN, APN-C)
Entity Type:Individual
Prefix:MRS
First Name:TANNIA
Middle Name:
Last Name:CUPERTINO
Suffix:
Gender:F
Credentials:MSN, RN, APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:MATAMORAS
Mailing Address - State:PA
Mailing Address - Zip Code:18336-1602
Mailing Address - Country:US
Mailing Address - Phone:570-491-5778
Mailing Address - Fax:
Practice Address - Street 1:390 CRYSTAL RUN RD
Practice Address - Street 2:WALLKILL MEDICAL ARTS BUILDING, SUITE 101
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4050
Practice Address - Country:US
Practice Address - Phone:845-695-6884
Practice Address - Fax:845-695-6886
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335385-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily