Individual provider Active NPI

Tabitha Lynn Tirado, LPN

  • Licensed Practical Nurse
  • Lake Grove, NY
National Provider Identifier
1700178506
Registry record updated May 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
304404 Issued in NY
Practice address
17 Sterling Dr
Lake Grove, NY 11755-2320
Phone
(631) 434-5393
NPI assigned
May 11, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 11, 2011

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 304404 NY Primary

Addresses

Primary practice location

17 Sterling Dr
Lake Grove, NY 11755-2320

Mailing address

17 Sterling Dr
Lake Grove, NY 11755-2320
Phone (631) 434-5393

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

State licenses

LicenseStateTypeSpecialty
304404NYMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1305072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305072000000",
    "number": "1700178506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 STERLING DR",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117552320",
            "telephone_number": "631-434-5393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 STERLING DR",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117552320",
            "telephone_number": "631-434-5393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIRADO",
        "first_name": "TABITHA",
        "middle_name": "LYNN",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-11",
        "last_updated": "2011-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "304404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Grove, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2011; 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.