Provider Demographics
NPI:1598986119
Name:TINGLEY, REBECCA COLLEEN (CRNA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:COLLEEN
Last Name:TINGLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MAIN ST SUITE K3502
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203
Mailing Address - Country:US
Mailing Address - Phone:315-339-1959
Mailing Address - Fax:315-339-1975
Practice Address - Street 1:1001 MAIN ST SUITE K3502
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-845-2300
Practice Address - Fax:716-845-8518
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY504986367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB9230Medicare PIN