Healthcare Provider Details

I. General information

NPI: 1144759549
Provider Name (Legal Business Name): JENNYLYN TANGONAN ESCRITOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 SYCAMORE DRIVE
BEACON NY
12508
US

IV. Provider business mailing address

32 SYCAMORE DR
BEACON NY
12508-3928
US

V. Phone/Fax

Practice location:
  • Phone: 845-392-0757
  • Fax:
Mailing address:
  • Phone: 845-392-0757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN770532
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number319560
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: