Provider Demographics
NPI:1154076602
Name:SARIC, TAJMA (RN)
Entity type:Individual
Prefix:
First Name:TAJMA
Middle Name:
Last Name:SARIC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TAJMA
Other - Middle Name:
Other - Last Name:CLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:100 KINGS HWY S STE 2500
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5509
Mailing Address - Country:US
Mailing Address - Phone:585-922-1520
Mailing Address - Fax:
Practice Address - Street 1:100 KINGS HWY S STE 2500
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-5509
Practice Address - Country:US
Practice Address - Phone:585-922-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY612357-01163WG0000X
NY406084363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice