Provider Demographics
NPI:1518459221
Name:TARLTON, OLGA (NP)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:TARLTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 LEFFERTS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4543
Mailing Address - Country:US
Mailing Address - Phone:212-803-3339
Mailing Address - Fax:646-768-8600
Practice Address - Street 1:555 LEFFERTS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225
Practice Address - Country:US
Practice Address - Phone:212-803-3339
Practice Address - Fax:646-768-8600
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1653083163W00000X
NY668773163W00000X
COAPN.0993886-NP363LA2200X
NY308598363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse