Healthcare Provider Details

I. General information

NPI: 1215720040
Provider Name (Legal Business Name): TIARRA GOINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2025
Last Update Date: 05/24/2025
Certification Date: 05/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 ELMWOOD AVE
BUFFALO NY
14217-1304
US

IV. Provider business mailing address

11 DEPEW AVE
BUFFALO NY
14214-1507
US

V. Phone/Fax

Practice location:
  • Phone: 716-447-6100
  • Fax:
Mailing address:
  • Phone: 716-931-3712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number960190
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: