Provider Demographics
NPI:1144642422
Name:TOLMASOV, INESSA (RN)
Entity type:Individual
Prefix:
First Name:INESSA
Middle Name:
Last Name:TOLMASOV
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65-65 BOOTH ST
Mailing Address - Street 2:APT 409
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:646-225-8802
Mailing Address - Fax:
Practice Address - Street 1:6565 BOOTH ST
Practice Address - Street 2:APT 409
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4160
Practice Address - Country:US
Practice Address - Phone:646-225-8802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY649648251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health