Provider Demographics
NPI:1194346668
Name:TOMKIN, THERESA MARIE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:TOMKIN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GREENE CT
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4362
Mailing Address - Country:US
Mailing Address - Phone:631-880-0716
Mailing Address - Fax:
Practice Address - Street 1:2 GREENE CT
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4362
Practice Address - Country:US
Practice Address - Phone:631-880-0716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308332363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health