Healthcare Provider Details

I. General information

NPI: 1417720319
Provider Name (Legal Business Name): TIAVIAN FRANCO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 SILVER CROSS BLVD
NEW LENOX IL
60451-9524
US

IV. Provider business mailing address

355 E ERIE ST
CHICAGO IL
60611-3167
US

V. Phone/Fax

Practice location:
  • Phone: 815-300-5400
  • Fax: 815-300-3576
Mailing address:
  • Phone: 312-238-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.028276
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209028276
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: