Provider Demographics
NPI:1851990840
Name:TOLENTINO, JOHN MARIUS AGRAVIO (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JOHN MARIUS
Middle Name:AGRAVIO
Last Name:TOLENTINO
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 S FORT APACHE RD STE 13
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-7700
Mailing Address - Country:US
Mailing Address - Phone:702-268-8900
Mailing Address - Fax:
Practice Address - Street 1:3557 WINTER WREN ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-3539
Practice Address - Country:US
Practice Address - Phone:702-445-4092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV835286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty