Provider Demographics
NPI:1962881722
Name:TOMASINO, KRISTIN (FNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:TOMASINO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:HUCEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:603 ANN ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5601
Mailing Address - Country:US
Mailing Address - Phone:815-347-3569
Mailing Address - Fax:
Practice Address - Street 1:3700 W 103RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-3105
Practice Address - Country:US
Practice Address - Phone:773-298-3712
Practice Address - Fax:773-298-3906
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.012131363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily