Provider Demographics
NPI:1548528326
Name:STONE, TINA ANN (RN)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:ANN
Last Name:STONE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 GATEWAY LN
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2528
Mailing Address - Country:US
Mailing Address - Phone:631-697-8058
Mailing Address - Fax:
Practice Address - Street 1:336 BLANCO DR
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-1021
Practice Address - Country:US
Practice Address - Phone:631-874-1345
Practice Address - Fax:631-874-1374
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY576822-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse