Provider Demographics
NPI:1306109806
Name:GUARINO, TINA J (APN-BC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:J
Last Name:GUARINO
Suffix:
Gender:F
Credentials:APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 CONWAY VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5806
Mailing Address - Country:US
Mailing Address - Phone:618-974-8894
Mailing Address - Fax:
Practice Address - Street 1:1066 EXECUTIVE PARKWAY DR STE 120
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6340
Practice Address - Country:US
Practice Address - Phone:314-744-8020
Practice Address - Fax:314-744-8021
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009366363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health