Provider Demographics
NPI:1083049191
Name:TOKOS, ERICA (FNP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:TOKOS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:MASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2580
Mailing Address - Country:US
Mailing Address - Phone:607-729-2144
Mailing Address - Fax:607-729-2145
Practice Address - Street 1:4417 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3556
Practice Address - Country:US
Practice Address - Phone:607-729-2144
Practice Address - Fax:607-729-2145
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338245363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03808572Medicaid