Healthcare Provider Details

I. General information

NPI: 1780169045
Provider Name (Legal Business Name): TAMMY HALKIAS AG-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PORT WASHINGTON BLVD
ROSLYN NY
11576-1347
US

IV. Provider business mailing address

15023 84TH AVE
JAMAICA NY
11432-1607
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF308778
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: