MEDICARE: LINDA KOVAC-TANTALO NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	401203	NY

General Provider Information

NPI Number	:	1013144534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA KOVAC-TANTALO NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	707 HAWKS NEST CIR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4894
Country	:	US
Telephone Number	:	585-738-9127
Fax Number	:

Provider Business Practice Location Address
First Line	:	1386 HATHAWAY DR
Second Line	:
City	:	FARMINGTON
State	:	NY
Zip	:	14425-8973
Country	:	US
Telephone Number	:	585-396-4190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2009
Last Update Date	:	05/18/2022

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