MEDICARE: MRS. TJADA S GARVIN

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	363L00000X	Nurse Practitioner	F311885	NY
2	163W00000X	Registered Nurse	578008	NY

General Provider Information

NPI Number	:	1679745699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TJADA S GARVIN

Provider Business Mailing Address
First Line	:	18 NORWOOD PL
Second Line	:
City	:	WYANDANCH
State	:	NY
Zip	:	11798-1029
Country	:	US
Telephone Number	:	631-805-6956
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 NORWOOD PL
Second Line	:
City	:	WYANDANCH
State	:	NY
Zip	:	11798-1029
Country	:	US
Telephone Number	:	631-805-6956
Fax Number	:

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

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	08/21/2024

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