Provider Demographics
NPI:1316224504
Name:BROWN, TYA NICOLE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:TYA
Middle Name:NICOLE
Last Name:BROWN
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 1:85 LINHOME DR
Mailing Address - Street 2:
Mailing Address - City:WEST HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-9962
Mailing Address - Country:US
Mailing Address - Phone:585-794-8085
Mailing Address - Fax:
Practice Address - Street 1:85 LINHOME DR
Practice Address - Street 2:
Practice Address - City:WEST HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14586-9962
Practice Address - Country:US
Practice Address - Phone:585-794-8085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300154164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse