Provider Demographics
NPI:1982226981
Name:JAMES, TANETTA NYOKA (FNP)
Entity Type:Individual
Prefix:
First Name:TANETTA
Middle Name:NYOKA
Last Name:JAMES
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 1:18823 DORMANS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2618
Mailing Address - Country:US
Mailing Address - Phone:347-209-5187
Mailing Address - Fax:
Practice Address - Street 1:18823 DORMANS RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2618
Practice Address - Country:US
Practice Address - Phone:347-209-5187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345246-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily