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NPI Code Detail

MEDICARE: TAMARA M HOLNESS

MEDICARE: TAMARA M HOLNESS
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
1164W00000XLicensed Practical Nurse307276NY
2163W00000XRegistered Nurse887850NY

General Provider Information

NPI Number : 1043573041
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMARA M HOLNESS
Provider Business Mailing Address
First Line : 1364 E 48TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-2104
Country : US
Telephone Number : 347-733-0478
Fax Number :
Provider Business Practice Location Address
First Line : 2811 QUEENS PLZ N FL 5
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11101-4172
Country : US
Telephone Number : 718-391-8300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2012
Last Update Date : 08/19/2024

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