Provider Demographics
NPI:1801154521
Name:TAMBA, YASUKO (MSN, RN, FNP-BC, CWS)
Entity type:Individual
Prefix:
First Name:YASUKO
Middle Name:
Last Name:TAMBA
Suffix:
Gender:F
Credentials:MSN, RN, FNP-BC, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MADISON AVENUE, FL 17TH
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017
Mailing Address - Country:US
Mailing Address - Phone:212-365-5066
Mailing Address - Fax:212-808-5510
Practice Address - Street 1:315 MADISON AVENUE FL 17TH
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:212-365-5066
Practice Address - Fax:212-808-5510
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00371400363LA2200X
PASP011878364SF0001X
NYF345321-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health