Healthcare Provider Details

I. General information

NPI: 1477186229
Provider Name (Legal Business Name): TANYA NELSON R.N. AND FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 INTERVALE AVE
BRONX NY
10459-4240
US

IV. Provider business mailing address

1432 5TH AVE
NEW YORK NY
10035-4521
US

V. Phone/Fax

Practice location:
  • Phone: 917-645-9200
  • Fax:
Mailing address:
  • Phone: 646-289-7700
  • Fax: 646-289-7791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number345885
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number695867
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: