Provider Demographics
NPI:1356802730
Name:PINO, IVONNE (APRN)
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:
Last Name:PINO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 ISLAND WAY APT 3D
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33767-2252
Mailing Address - Country:US
Mailing Address - Phone:815-603-8853
Mailing Address - Fax:
Practice Address - Street 1:2701 PARK DR STE 7
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1021
Practice Address - Country:US
Practice Address - Phone:888-707-3436
Practice Address - Fax:727-669-7841
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily