Provider Demographics
NPI:1366814378
Name:CARRINO, JOHN-THOMAS (PA)
Entity type:Individual
Prefix:
First Name:JOHN-THOMAS
Middle Name:
Last Name:CARRINO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 TUSCULUM BLVD
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4286
Mailing Address - Country:US
Mailing Address - Phone:423-638-1291
Mailing Address - Fax:423-638-9398
Practice Address - Street 1:1410 TUSCULUM BLVD
Practice Address - Street 2:SUITE 2500
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4286
Practice Address - Country:US
Practice Address - Phone:423-638-1291
Practice Address - Fax:423-638-9398
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2876363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant