Provider Demographics
NPI:1447533534
Name:TINO, NICOLE CHRISTINE (PA-C)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:CHRISTINE
Last Name:TINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 HIGH RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-1936
Mailing Address - Country:US
Mailing Address - Phone:860-485-3565
Mailing Address - Fax:
Practice Address - Street 1:353 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4145
Practice Address - Country:US
Practice Address - Phone:860-649-3477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-24
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002647363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant