Provider Demographics
NPI:1477136307
Name:TANIGUCHI, KRISTIN A
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:A
Last Name:TANIGUCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ALYSE
Other - Last Name:TANIGUCHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1444 WESTERN AVE STE B2
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3440
Practice Address - Country:US
Practice Address - Phone:518-458-8014
Practice Address - Fax:518-533-6714
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY351309363LF0000X
CA95017066363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner