Individual
LINDA KOVAC-TANTALO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1386 HATHAWAY DR, FARMINGTON, NY 14425-8973
(585) 396-4190
Mailing address
707 HAWKS NEST CIR, ROCHESTER, NY 14626-4894
(585) 738-9127
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
401203
NY
Other
Enumeration date
06/11/2009
Last updated
05/18/2022
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