MEDICARE: MISS YASSAM TIFFANY OSBOURNE REGISTERED NURSE

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	164W00000X	Licensed Practical Nurse	321541-1	NY
2	163W00000X	Registered Nurse	743898	NY

General Provider Information

NPI Number	:	1598211013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS YASSAM TIFFANY OSBOURNE REGISTERED NURSE

Provider Business Mailing Address
First Line	:	416 LINCOLN AVE
Second Line	:
City	:	CLIFFSIDE PARK
State	:	NJ
Zip	:	07010-1821
Country	:	US
Telephone Number	:	914-433-3335
Fax Number	:

Provider Business Practice Location Address
First Line	:	416 LINCOLN AVE
Second Line	:
City	:	CLIFFSIDE PARK
State	:	NJ
Zip	:	07010-1821
Country	:	US
Telephone Number	:	914-433-3335
Fax Number	:

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

Provider Enumeration Date	:	08/26/2016
Last Update Date	:	06/16/2019

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