Provider Demographics
NPI:1891757068
Name:TOMMASINO, ANN SASSONE (CRNA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:SASSONE
Last Name:TOMMASINO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:SASSONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-3302
Mailing Address - Fax:716-332-3525
Practice Address - Street 1:116 INTERSTATE PKWY
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-1036
Practice Address - Country:US
Practice Address - Phone:814-362-8674
Practice Address - Fax:814-362-8695
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024141878367500000X
PARN292119L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1891757068Medicaid
VAMC12189Medicare PIN
VA1891757068Medicaid