Provider Demographics
NPI:1881369486
Name:TEMPLE, TIJUANA (FNP)
Entity type:Individual
Prefix:
First Name:TIJUANA
Middle Name:
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 PENNAQUID RD
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1227
Mailing Address - Country:US
Mailing Address - Phone:631-605-1783
Mailing Address - Fax:
Practice Address - Street 1:65 PENNAQUID RD
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-1227
Practice Address - Country:US
Practice Address - Phone:631-605-1783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348067363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily