Basic Information
| Provider Information | |||||||||
| NPI: | 1427177526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TINI | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | BETH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 763 BURNSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | EAST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061082791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602919787 | ||||||||
| FaxNumber: | 8602919728 | ||||||||
| Practice Location | |||||||||
| Address1: | 763 BURNSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | EAST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061082791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602919787 | ||||||||
| FaxNumber: | 8602919728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 08/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 002648 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.