Provider Demographics
NPI:1801600994
Name:BEDROSSIAN, TINA (FNP)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:BEDROSSIAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N JACKSON ST APT 301
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3608
Mailing Address - Country:US
Mailing Address - Phone:818-653-5778
Mailing Address - Fax:
Practice Address - Street 1:3811 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3904
Practice Address - Country:US
Practice Address - Phone:818-232-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95109215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily