Provider Demographics
NPI:1306509971
Name:POLINTAN, MARK MAXILOM (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:MAXILOM
Last Name:POLINTAN
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:MAXILOM
Other - Last Name:POLINTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:732 S 6TH ST STE N
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-6948
Mailing Address - Country:US
Mailing Address - Phone:725-772-1939
Mailing Address - Fax:
Practice Address - Street 1:732 S 6TH ST STE N
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-6948
Practice Address - Country:US
Practice Address - Phone:725-772-1939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349083363LF0000X
TX1099927363LF0000X
PASP024314363LF0000X
NJ26NJ01261800363LF0000X
MN12488363LF0000X
FLTPAN3116363LF0000X
CA95025693363LF0000X
AZ319429363LF0000X
NV860179363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily