Healthcare Provider Details

I. General information

NPI: 1679093181
Provider Name (Legal Business Name): ELAINE TOLAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 6TH ST STE 1J
BROOKLYN NY
11215-3671
US

IV. Provider business mailing address

501 6TH ST STE 1J
BROOKLYN NY
11215-3671
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-3070
  • Fax: 718-246-8611
Mailing address:
  • Phone: 718-780-3070
  • Fax: 718-246-8611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number717867
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF342682-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: