Healthcare Provider Details

I. General information

NPI: 1003968264
Provider Name (Legal Business Name): TANYKA K SMITH FNP, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 BEDFORD AVE
BROOKLYN NY
11210-2850
US

IV. Provider business mailing address

2900 BEDFORD AVE
BROOKLYN NY
11210-2850
US

V. Phone/Fax

Practice location:
  • Phone: 718-951-5580
  • Fax:
Mailing address:
  • Phone: 718-951-5580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number334626
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: