Provider Demographics
NPI:1629882642
Name:TANO, AMBROISE A
Entity type:Individual
Prefix:
First Name:AMBROISE
Middle Name:A
Last Name:TANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 AMESBURY ST
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-5648
Mailing Address - Country:US
Mailing Address - Phone:978-844-0328
Mailing Address - Fax:781-558-9157
Practice Address - Street 1:210 AMESBURY ST
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-5648
Practice Address - Country:US
Practice Address - Phone:978-844-0328
Practice Address - Fax:781-558-9157
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2023207485363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health