Provider Demographics
NPI:1154800811
Name:BRUNO, TINO (FNP-C, TRT)
Entity type:Individual
Prefix:
First Name:TINO
Middle Name:
Last Name:BRUNO
Suffix:
Gender:M
Credentials:FNP-C, TRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 E OGDEN AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8610
Mailing Address - Country:US
Mailing Address - Phone:630-857-3101
Mailing Address - Fax:630-857-3596
Practice Address - Street 1:1020 E OGDEN AVE STE 206
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8610
Practice Address - Country:US
Practice Address - Phone:630-857-3101
Practice Address - Fax:630-857-3596
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.017681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid