Provider Demographics
NPI:1245653435
Name:ESPERANCE, THAMAR JEAN
Entity type:Individual
Prefix:
First Name:THAMAR
Middle Name:JEAN
Last Name:ESPERANCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 570
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-0570
Mailing Address - Country:US
Mailing Address - Phone:854-598-1650
Mailing Address - Fax:
Practice Address - Street 1:3 CENTRAL AVE W
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1701
Practice Address - Country:US
Practice Address - Phone:845-598-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274990-1164W00000X
NJ26NP06990600164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse