Provider Demographics
NPI:1215927751
Name:TUDINI, JOAN BEATRICE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:BEATRICE
Last Name:TUDINI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-1560
Mailing Address - Country:US
Mailing Address - Phone:716-652-1560
Mailing Address - Fax:716-652-0018
Practice Address - Street 1:292 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-1650
Practice Address - Country:US
Practice Address - Phone:716-652-1560
Practice Address - Fax:716-652-0018
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236991163WX0106X
NYF-301348-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00535829001OtherBCBS WNY
NY1215927751OtherUNIVERA
NY9512618OtherIHA
NY03605341Medicaid
NY1215927751OtherUNIVERA