Individual
TABETHA TANAE TYNDALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1477 HYLAN BLVD, STATEN ISLAND, NY 10305-1906
(718) 979-6900
Mailing address
189 W BUCHANAN ST, STATEN ISLAND, NY 10301-1224
(347) 466-2608
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
287510-1
NY
363LG0600X
Gerontology Nurse Practitioner
Primary
310924
NY
Other
Enumeration date
08/21/2008
Last updated
02/20/2025
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