Healthcare Provider Details

I. General information

NPI: 1881171296
Provider Name (Legal Business Name): TINA FRANCINE DRAKE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 SARA CT
ELK GROVE VILLAGE IL
60007-2900
US

IV. Provider business mailing address

0S028 FORBES DR
GENEVA IL
60134-6027
US

V. Phone/Fax

Practice location:
  • Phone: 423-665-9272
  • Fax:
Mailing address:
  • Phone: 847-322-5443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209017456
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: