Healthcare Provider Details

I. General information

NPI: 1982520193
Provider Name (Legal Business Name): TENDER LOVING CARE NURSE PRACTITIONER IN PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 NY-111
SMITHTOWN NY
11787
US

IV. Provider business mailing address

62 WOODYCREST DR
FARMINGVILLE NY
11738-2847
US

V. Phone/Fax

Practice location:
  • Phone: 631-771-8521
  • Fax:
Mailing address:
  • Phone: 631-771-8521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: OLUWATOBI OLAOFE
Title or Position: OWNER
Credential:
Phone: 631-771-8521