Healthcare Provider Details

I. General information

NPI: 1356694392
Provider Name (Legal Business Name): HEATHER MARTONE TARANTINO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 CROWN AVE
STATEN ISLAND NY
10312-2743
US

IV. Provider business mailing address

242 MASON AVE
STATEN ISLAND NY
10305-3408
US

V. Phone/Fax

Practice location:
  • Phone: 347-837-0687
  • Fax:
Mailing address:
  • Phone: 718-987-0128
  • Fax: 718-987-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number337632
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: