Doctor Name: | MISS JANICE CHANDRA TARA |
NPI Number: | 1043552797 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ANP |
License Number: | #A1212034 |
Business Practice Address: | 3 Heathcote Rd 3 Elmont, NY - 11003 |
Business Phone Number: | 5163289843 |
Business Fax Number: | |
Mailing Address: | 3 Heathcote Rd, Elmont ELMONT |
State: | NY |
Postal Code: | 110031402 |
Phone Number: | 5163289843 |
Fax Number: | |
NPI Enumeration Date: | 03/20/2013 |
NPI Last Update Date: | 03/25/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | #A1212034 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |