Provider Demographics
NPI:1619300894
Name:BRUNO, TIANA ROSE (NP)
Entity Type:Individual
Prefix:MRS
First Name:TIANA
Middle Name:ROSE
Last Name:BRUNO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-3431
Mailing Address - Country:US
Mailing Address - Phone:978-771-0859
Mailing Address - Fax:
Practice Address - Street 1:480 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-3776
Practice Address - Country:US
Practice Address - Phone:781-941-2241
Practice Address - Fax:781-941-2240
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2277754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily