Provider Demographics
NPI:1871868372
Name:TOLOK, TATYANA (RN)
Entity Type:Individual
Prefix:MISS
First Name:TATYANA
Middle Name:
Last Name:TOLOK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2813
Mailing Address - Country:US
Mailing Address - Phone:718-369-7603
Mailing Address - Fax:718-499-4948
Practice Address - Street 1:350 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2813
Practice Address - Country:US
Practice Address - Phone:718-369-7603
Practice Address - Fax:718-499-4948
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY502203163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool