Healthcare Provider Details

I. General information

NPI: 1962345520
Provider Name (Legal Business Name): TIANNA MAKOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870 POST RD
WARWICK RI
02886-3169
US

IV. Provider business mailing address

46 URQUHART ST
CRANSTON RI
02920-6421
US

V. Phone/Fax

Practice location:
  • Phone: 401-352-0007
  • Fax:
Mailing address:
  • Phone: 401-212-9655
  • Fax: 401-212-9655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN05110
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: