Hustace, Tally

Hustace, Tally is an individual health care provider with primary practice located at 1601 Nw 12Th Ave Box 016960 M851, Miami FL 33101-6960. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Nursing Service Providers / Pediatrics. Nursing Service Providers / Pediatrics is her primary health care specialty. Hustace, Tally can be contacted via phone (305) 243-4029.

Contact Information

Primary practice address
1601 Nw 12Th Ave Box 016960 M851 Miami FL 33101-6960
Phone: (305) 243-4029
Fax: (305) 243-8470
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X ARNP3067572 Florida
Nursing Service Providers / Pediatrics 163WP0200X ARNP3067572 Florida

Profile Details

NPI number 1356379416
LBN Legal business name Hustace, Tally
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 29th, 2006
Last updated Jan 20th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356379416 NPPES
Florida MEDICAID 3059677-00

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