Provider Demographics
NPI:1780418616
Name:VANTINO, TRICIA
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:VANTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8690 KAROLENA PL NE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-8822
Mailing Address - Country:US
Mailing Address - Phone:360-689-6283
Mailing Address - Fax:
Practice Address - Street 1:8690 KAROLENA PL NE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-8822
Practice Address - Country:US
Practice Address - Phone:360-689-6283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61095929163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine