Provider Demographics
NPI:1720554694
Name:MCCUNE, TINA MARIE (CRNP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:MCCUNE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 CHAMBERS LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-6948
Mailing Address - Country:US
Mailing Address - Phone:610-299-8455
Mailing Address - Fax:
Practice Address - Street 1:825 OLD LANCASTER RD STE 320
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3235
Practice Address - Country:US
Practice Address - Phone:610-527-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019329363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health