Provider Demographics
NPI:1225380132
Name:POYNER, TARA LINETTE
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LINETTE
Last Name:POYNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PONDVIEW DR APT 13
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-6838
Mailing Address - Country:US
Mailing Address - Phone:631-627-8296
Mailing Address - Fax:
Practice Address - Street 1:7 PONDVIEW DR APT 13
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-6838
Practice Address - Country:US
Practice Address - Phone:631-627-8296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300241164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse