Healthcare Provider Details

I. General information

NPI: 1437066933
Provider Name (Legal Business Name): TIANA LESTINA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 CHESTNUT AVE STE 101
GLENVIEW IL
60026-1674
US

IV. Provider business mailing address

130 E WILMETTE AVE
PALATINE IL
60067-7247
US

V. Phone/Fax

Practice location:
  • Phone: 847-243-6041
  • Fax:
Mailing address:
  • Phone: 224-612-0026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.036450
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: