Healthcare Provider Details

I. General information

NPI: 1144140732
Provider Name (Legal Business Name): LAURA TIERNO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA TIERNO-GROUTAS FNP

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMUNITY DR
MANHASSET NY
11030-3816
US

IV. Provider business mailing address

300 COMMUNITY DR
MANHASSET NY
11030-3816
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-1624
  • Fax:
Mailing address:
  • Phone: 516-562-1624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF360113-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: