Provider Demographics
NPI:1740631068
Name:VACANTE, TINA GRACE (MSN, FNP-BC, RN-BC)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:GRACE
Last Name:VACANTE
Suffix:
Gender:F
Credentials:MSN, FNP-BC, RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PROSPECT AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1999
Mailing Address - Country:US
Mailing Address - Phone:551-996-4849
Mailing Address - Fax:551-996-5703
Practice Address - Street 1:20 PROSPECT AVE STE 201
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1999
Practice Address - Country:US
Practice Address - Phone:551-996-4849
Practice Address - Fax:551-996-5703
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00630000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily