Healthcare Provider Details

I. General information

NPI: 1164006656
Provider Name (Legal Business Name): TARYN ACHONG RN, DNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 6TH ST.
LANAI CITY HI
96763-9676
US

IV. Provider business mailing address

333 6TH ST.
LANAI CITY HI
96763-3517
US

V. Phone/Fax

Practice location:
  • Phone: 808-565-6919
  • Fax:
Mailing address:
  • Phone: 808-330-7608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number97054
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3286
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: