Provider Demographics
NPI:1992819114
Name:MACE, TANNA NICOLE (APRN, BC, FNP)
Entity type:Individual
Prefix:MRS
First Name:TANNA
Middle Name:NICOLE
Last Name:MACE
Suffix:
Gender:F
Credentials:APRN, BC, FNP
Other - Prefix:MISS
Other - First Name:TANNA
Other - Middle Name:NICOLE
Other - Last Name:TRAUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, BC, FNP
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-0026
Mailing Address - Country:US
Mailing Address - Phone:585-305-8059
Mailing Address - Fax:
Practice Address - Street 1:800 CARTER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2604
Practice Address - Country:US
Practice Address - Phone:585-305-8059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333530-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF333530OtherFNP LICENSE
NY507810-1OtherRN LICENSE
NY0366409-22OtherANCC CERTIFICATION
NY0366409-22OtherANCC CERTIFICATION
NYF333530OtherFNP LICENSE