MEDICARE: MARK TRISTAN MARIANO DEGUZMAN 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	163W00000X	Registered Nurse	691581	NY
2	363LF0000X	Family Nurse Practitioner	341549	NY

General Provider Information

NPI Number	:	1558818799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK TRISTAN MARIANO DEGUZMAN FNP

Provider Business Mailing Address
First Line	:	3144 3RD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-4629
Country	:	US
Telephone Number	:	212-271-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3144 3RD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-4629
Country	:	US
Telephone Number	:	212-271-7200
Fax Number	:

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

Provider Enumeration Date	:	09/06/2016
Last Update Date	:	03/13/2025

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