Provider Demographics
NPI:1700341104
Name:SMITH, TARNISHA (LPN)
Entity Type:Individual
Prefix:
First Name:TARNISHA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 METROPOLITAN OVAL
Mailing Address - Street 2:APT. MH
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6444
Mailing Address - Country:US
Mailing Address - Phone:917-736-1604
Mailing Address - Fax:
Practice Address - Street 1:99 METROPOLITAN OVAL
Practice Address - Street 2:APT. MH
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-6444
Practice Address - Country:US
Practice Address - Phone:917-736-1604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-10
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330879164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse