Individual
TANISHA P. HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, APRN, FNP-C
Contact information
Practice address
1312 GRAND AVE, NORTH BALDWIN, NY 11510-1418
(516) 417-6797
Mailing address
PO BOX 1276, BALDWIN, NY 11510-0876
(516) 417-6797
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
26RN18111600
NJ
163W00000X
Registered Nurse
574808-1
NY
363L00000X
Nurse Practitioner
26NJ00927600
NJ
363LP2300X
Primary Care Nurse Practitioner
Primary
26NJ00927600
NJ
Other
Enumeration date
10/16/2019
Last updated
10/16/2019
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