Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 401203 | NY |
NPI | 1013144534 |
---|---|
Provider Name | Linda Kovac-Tantalo |
First Address | Rochester, NY 14612-6202 |
Second Address | Rochester, NY 14621-3001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2009 |
Last Update Date | 11/06/2009 |