Provider Demographics
NPI:1750928578
Name:ARCIELLO, TASHA RENEE (AGNP-C)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:RENEE
Last Name:ARCIELLO
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 GALLIS HILL RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-7504
Mailing Address - Country:US
Mailing Address - Phone:914-466-3636
Mailing Address - Fax:
Practice Address - Street 1:211 HURLEY AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-2400
Practice Address - Country:US
Practice Address - Phone:845-339-2804
Practice Address - Fax:845-339-5312
Is Sole Proprietor?:No
Enumeration Date:2019-12-01
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY554372163W00000X
NY309535363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse