Provider Demographics
NPI:1972067080
Name:ZIMINSKY, TANYA ELISE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:ELISE
Last Name:ZIMINSKY
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 1:529 MAIN ST STE 222
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1101
Mailing Address - Country:US
Mailing Address - Phone:617-600-3195
Mailing Address - Fax:
Practice Address - Street 1:529 MAIN ST STE 222
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-1101
Practice Address - Country:US
Practice Address - Phone:617-600-3195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2289813363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care