Provider Demographics
NPI:1780559658
Name:PANTALEO, TAYA ROSE (FNP-BC)
Entity type:Individual
Prefix:
First Name:TAYA
Middle Name:ROSE
Last Name:PANTALEO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1892 KIRTS BLVD APT 216
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4373
Mailing Address - Country:US
Mailing Address - Phone:586-612-8086
Mailing Address - Fax:
Practice Address - Street 1:1892 KIRTS BLVD APT 216
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4373
Practice Address - Country:US
Practice Address - Phone:586-612-8086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704363283363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily