1992819114 NPI number — MRS. TANNA NICOLE MACE APRN, BC, FNP

Table of content: MRS. TANNA NICOLE MACE APRN, BC, FNP (NPI 1992819114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992819114 NPI number — MRS. TANNA NICOLE MACE APRN, BC, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACE
Provider First Name:
TANNA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, BC, FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRAUB
Provider Other First Name:
TANNA
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN, BC, FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992819114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEBSTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14580-0026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-305-8059
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 CARTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14621-2604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-305-8059
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  F333530-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F333530 . This is a "FNP LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 507810-1 . This is a "RN LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0366409-22 . This is a "ANCC CERTIFICATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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