# MRS. TINA KATSARIKAS MCGILLICUDDY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1467585414
- **Gender:** F
- **Credential:** APRN NURSE PRACTITIO

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133V00000X | Registered Dietitian | 151957 | TN | — |
| 163W00000X | Registered Nurse | 079084 | CT | — |
| 363LP0200X | Pediatric Nurse Practitioner | 003531 | CT | Yes |

## Other

- **Enumeration date:** 03/13/2007
- **Last updated:** 12/12/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 004235900 | — | CT |