Provider Demographics
NPI:1275100117
Name:TEJADA, CAROLINA ANDRINA (LPN)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:ANDRINA
Last Name:TEJADA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 SAINT PAUL BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-4563
Mailing Address - Country:US
Mailing Address - Phone:315-913-5300
Mailing Address - Fax:
Practice Address - Street 1:2450 SAINT PAUL BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-4563
Practice Address - Country:US
Practice Address - Phone:315-913-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340162-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse