Healthcare Provider Details

I. General information

NPI: 1235757931
Provider Name (Legal Business Name): TIFFANY ROSE MAGNO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE HEALTHY WAY
OCEANSIDE NY
11572
US

IV. Provider business mailing address

7011 108TH ST APT 3K
FLUSHING NY
11375-4406
US

V. Phone/Fax

Practice location:
  • Phone: 516-632-3000
  • Fax:
Mailing address:
  • Phone: 917-574-3484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number690698
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: