Provider Demographics
NPI:1881168284
Name:TINNERELLO, MARY-ELLEN DORATHY KATRINA (APRN)
Entity type:Individual
Prefix:MRS
First Name:MARY-ELLEN
Middle Name:DORATHY KATRINA
Last Name:TINNERELLO
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 1:4664 BROWNING CT
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5730
Mailing Address - Country:US
Mailing Address - Phone:910-568-2028
Mailing Address - Fax:
Practice Address - Street 1:4664 BROWNING CT
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-5730
Practice Address - Country:US
Practice Address - Phone:910-568-2028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9327432363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily