MEDICARE: HEATHER MARTONE TARANTINO FNP

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	363LF0000X	Family Nurse Practitioner	337632	NY

General Provider Information

NPI Number	:	1356694392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MARTONE TARANTINO FNP

Provider Business Mailing Address
First Line	:	242 MASON AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3408
Country	:	US
Telephone Number	:	718-987-0128
Fax Number	:	718-987-0223

Provider Business Practice Location Address
First Line	:	456 CROWN AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-2743
Country	:	US
Telephone Number	:	347-837-0687
Fax Number	:

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

Provider Enumeration Date	:	10/15/2012
Last Update Date	:	09/16/2016

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