Provider Demographics
NPI:1811598790
Name:TANKE, NATALIE (FNP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:TANKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:DICESARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:145 MARBLE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-1341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-279-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY657613163W00000X
NY3469072086S0129X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery