Healthcare Provider Details

I. General information

NPI: 1568026672
Provider Name (Legal Business Name): TIFFANY BLISS THALAPPILLIL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY BLISS JONES

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTHY WAY
OCEANSIDE NY
11572-1551
US

IV. Provider business mailing address

23 CRESCENT RD
GREAT NECK NY
11021-2701
US

V. Phone/Fax

Practice location:
  • Phone: 516-632-3000
  • Fax:
Mailing address:
  • Phone: 719-930-5099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344202
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: