1043704349 NPI number — DR. TINA TERESA MOND DNP, APRN-FPA

Table of content: DR. TINA TERESA MOND DNP, APRN-FPA (NPI 1043704349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043704349 NPI number — DR. TINA TERESA MOND DNP, APRN-FPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOND
Provider First Name:
TINA
Provider Middle Name:
TERESA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP, APRN-FPA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043704349
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2810 FRANK SCOTT PARKWAY, WEST
Provider Second Line Business Mailing Address:
SUITE 708
Provider Business Mailing Address City Name:
BELLEVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62223-5007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-252-8704
Provider Business Mailing Address Fax Number:
251-873-1836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2810 FRANK SCOTT PARKWAY WEST
Provider Second Line Business Practice Location Address:
SUITE 708
Provider Business Practice Location Address City Name:
BELLEVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62223-5007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-252-8704
Provider Business Practice Location Address Fax Number:
251-873-1836
Provider Enumeration Date:
06/19/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  277002222 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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