Provider Demographics
NPI:1316097280
Name:TINDALL, JACQUELINE S (NP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:S
Last Name:TINDALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-2209
Mailing Address - Country:US
Mailing Address - Phone:716-848-2000
Mailing Address - Fax:
Practice Address - Street 1:425 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-2209
Practice Address - Country:US
Practice Address - Phone:716-848-2123
Practice Address - Fax:716-848-2125
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332396363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP35888Medicare UPIN