Provider Demographics
NPI:1437784493
Name:TARANTO, NICOLE RODRIGUEZ (FNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RODRIGUEZ
Last Name:TARANTO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1100 SOUTH AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3410
Mailing Address - Country:US
Mailing Address - Phone:718-226-4645
Mailing Address - Fax:212-475-8487
Practice Address - Street 1:1100 SOUTH AVE STE 305
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3410
Practice Address - Country:US
Practice Address - Phone:718-226-4645
Practice Address - Fax:718-226-4670
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345605363LF0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily