Healthcare Provider Details

I. General information

NPI: 1316750862
Provider Name (Legal Business Name): JO-AN TIZON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3804 BAILEY AVE
BRONX NY
10463-2537
US

IV. Provider business mailing address

3804 BAILEY AVE
BRONX NY
10463-2537
US

V. Phone/Fax

Practice location:
  • Phone: 213-569-4922
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number790905
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: