Provider Demographics
NPI:1184969255
Name:TANCREDI, CHRISTINE M (NP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:TANCREDI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:NY
Mailing Address - Zip Code:13042-2144
Mailing Address - Country:US
Mailing Address - Phone:866-916-5259
Mailing Address - Fax:231-922-4030
Practice Address - Street 1:723 CENTER ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:NY
Practice Address - Zip Code:13042-2144
Practice Address - Country:US
Practice Address - Phone:866-916-5259
Practice Address - Fax:231-922-4030
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333735363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner