Provider Demographics
NPI:1336405802
Name:MYRTHIL, TANIA (RN)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:MYRTHIL
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 1:42 TOC DR UNIT 602
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1556
Mailing Address - Country:US
Mailing Address - Phone:516-467-9250
Mailing Address - Fax:845-834-2968
Practice Address - Street 1:42 TOC DR UNIT 602
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-1556
Practice Address - Country:US
Practice Address - Phone:516-467-9250
Practice Address - Fax:845-834-2968
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY654164163WN0002X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No163W00000XNursing Service ProvidersRegistered Nurse