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NPI Code Detail

MEDICARE: MISS TANYA M WATSON

MEDICARE: MISS TANYA M WATSON
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
1363LP2300XPrimary Care Nurse PractitionerF308751-1NY

General Provider Information

NPI Number : 1518587237
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS TANYA M WATSON
Provider Business Mailing Address
First Line : 25320 147TH RD
Second Line :
City : ROSEDALE
State : NY
Zip : 11422-2826
Country : US
Telephone Number : 917-515-3686
Fax Number :
Provider Business Practice Location Address
First Line : 1440 PORT WASHINGTON BLVD
Second Line :
City : PORT WASHINGTON
State : NY
Zip : 11050-2412
Country : US
Telephone Number : 516-849-7854
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2020
Last Update Date : 04/22/2020

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Directions to “ MISS TANYA M WATSON ” Practice Location

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