Provider Demographics
NPI:1174075774
Name:TYNER, SARAH JANE (MSN, RN, NNP)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JANE
Last Name:TYNER
Suffix:
Gender:F
Credentials:MSN, RN, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7675 POPLAR FIELD CIR
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9350
Mailing Address - Country:US
Mailing Address - Phone:305-915-5133
Mailing Address - Fax:315-638-6240
Practice Address - Street 1:7675 POPLAR FIELD CIR
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9350
Practice Address - Country:US
Practice Address - Phone:305-915-5133
Practice Address - Fax:315-638-6240
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-30
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35-350409363LN0000X
NY350409363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner