Provider Demographics
NPI:1740039890
Name:OPSENICA, TINA M (APRN)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:OPSENICA
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 1:10260 191ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8802
Mailing Address - Country:US
Mailing Address - Phone:708-425-1907
Mailing Address - Fax:708-422-4253
Practice Address - Street 1:10260 191ST ST STE 100
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8802
Practice Address - Country:US
Practice Address - Phone:708-425-1907
Practice Address - Fax:708-422-4253
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.029645363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily