MEDICARE: MARK TOLSMA APN

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	363LF0000X	Family Nurse Practitioner	26NJ14890200	NJ

General Provider Information

NPI Number	:	1902588700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK TOLSMA APN

Provider Business Mailing Address
First Line	:	46 SCHOOL ST
Second Line	:
City	:	NORTH HALEDON
State	:	NJ
Zip	:	07508-2529
Country	:	US
Telephone Number	:	551-697-4209
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 PARK WAY
Second Line	:
City	:	UPPER SADDLE RIVER
State	:	NJ
Zip	:	07458-2345
Country	:	US
Telephone Number	:	201-882-7526
Fax Number	:

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

Provider Enumeration Date	:	08/02/2023
Last Update Date	:	08/02/2023

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