Provider Demographics
NPI:1821702598
Name:MILLAR, TANYA NICOLE (FNP)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:NICOLE
Last Name:MILLAR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CARL BRASHEAR DR
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-5502
Mailing Address - Country:US
Mailing Address - Phone:347-393-1831
Mailing Address - Fax:
Practice Address - Street 1:754 KLONDIKE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4824
Practice Address - Country:US
Practice Address - Phone:646-359-0935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY546396-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily