Individual provider Active NPI

Tanya Holland

  • Licensed Practical Nurse
  • Bay Shore, NY
National Provider Identifier
1104163930
Registry record updated Jan 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
309817 Issued in NY
Practice address
119 Pine Aire Dr
Bay Shore, NY 11706-1103
Phone
(631) 579-6310
NPI assigned
Jan 14, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 14, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 309817 NY Primary

Addresses

Primary practice location

119 Pine Aire Dr
Bay Shore, NY 11706-1103

Mailing address

119 Pine Aire Dr
Bay Shore, NY 11706-1103

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358121600000",
    "number": "1104163930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 PINE AIRE DR",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117061103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 PINE AIRE DR",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117061103",
            "telephone_number": "631-579-6310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLAND",
        "first_name": "TANYA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-14",
        "last_updated": "2013-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "309817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay Shore, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.