MEDICARE: TENDER CARE NP IN FAMILY HEALTH

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	261QC1500X	Community Health Clinic/Center
2	363LF0000X	Family Nurse Practitioner	33-3372244	NY

General Provider Information

NPI Number	:	1710359179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENDER CARE NP IN FAMILY HEALTH

Provider Business Mailing Address
First Line	:	1141 E 56TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2411
Country	:	US
Telephone Number	:	347-409-6288
Fax Number	:

Provider Business Practice Location Address
First Line	:	316 ROCKAWAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-3369
Country	:	US
Telephone Number	:	347-409-6288
Fax Number	:

Authorized Official
Title or Position	:	NP
Name	:	KEISHA BURRELL
Credential	:
Telephone Number	:	347-409-6288

Provider Enumeration Date	:	10/26/2015
Last Update Date	:	11/08/2021

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