Provider Demographics
NPI:1043704349
Name:MOND, TINA TERESA (DNP, APRN-FPA)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:TERESA
Last Name:MOND
Suffix:
Gender:
Credentials:DNP, APRN-FPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 FRANK SCOTT PARKWAY, WEST
Mailing Address - Street 2:SUITE 708
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-5007
Mailing Address - Country:US
Mailing Address - Phone:314-252-8704
Mailing Address - Fax:251-873-1836
Practice Address - Street 1:2810 FRANK SCOTT PARKWAY WEST
Practice Address - Street 2:SUITE 708
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-5007
Practice Address - Country:US
Practice Address - Phone:314-252-8704
Practice Address - Fax:251-873-1836
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277002222363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty