Individual ProviderTandika BoatswainNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2015 Grand Concourse, Bronx, NY 10453-4303(718) 299-7295(718) 618-0401PECOS EnrollmentBased on the most recent information from CMS, provider Tandika Boatswain is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1003163742Provider TypeIndividualFull NameBoatswain, TandikaCredentialNPGenderFemaleSole ProprietorNoEnumeration Date8/13/2012Last Updated3/23/2022Contact InformationPractice LocationPractice Address2015 Grand Concourse, Bronx, NY 10453-4303Phone(718) 299-7295Fax(718) 299-6797Mailing LocationMailing Address2626 Halperin Ave, Bronx, NY 10461-2631Phone(718) 618-0401Fax(347) 479-1303Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseF344907New YorkProvider IdentifiersIDDescriptionIssuerID660314DescriptionOtherIssuerRN LICENSE 660314New York