Provider Demographics
NPI:1164006656
Name:ACHONG, TARYN (RN, DNP, FNP)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:
Last Name:ACHONG
Suffix:
Gender:F
Credentials:RN, DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 6TH ST.
Mailing Address - Street 2:
Mailing Address - City:LANAI CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96763-3517
Mailing Address - Country:US
Mailing Address - Phone:808-330-7608
Mailing Address - Fax:
Practice Address - Street 1:333 6TH ST.
Practice Address - Street 2:
Practice Address - City:LANAI CITY
Practice Address - State:HI
Practice Address - Zip Code:96763-9676
Practice Address - Country:US
Practice Address - Phone:808-565-6919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI97054163W00000X
HI3286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse