Provider Demographics
NPI:1790226629
Name:BASTIAN, TINU (ARNP)
Entity Type:Individual
Prefix:MS
First Name:TINU
Middle Name:
Last Name:BASTIAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 MIDDLEBURY RD
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-2712
Mailing Address - Country:US
Mailing Address - Phone:319-467-6789
Mailing Address - Fax:
Practice Address - Street 1:3640 MIDDLEBURY RD
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2712
Practice Address - Country:US
Practice Address - Phone:319-467-6789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-11
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA129477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily