Provider Demographics
NPI:1487415493
Name:CROSSNO, TATIANA (LAC)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:CROSSNO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:
Other - Last Name:SORRENTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:117 STARLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-6153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:308 N MAPLE ST APT B
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2347
Practice Address - Country:US
Practice Address - Phone:516-551-4622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC259171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist