Tyissha K Penn | Bronx, NY • PECOS Search

Tyissha K Penn

Registered Nurse

Nursing Service Providers

1155 E 221st St, Bronx, NY 10469-1505

PECOS Enrollment

Based on the most recent information from CMS, provider Tyissha K Penn does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 7 days ago.

Profile Details

Provider ID
1386236925
Provider Type
Individual
Full Name
Penn, Tyissha K
Gender
Female

Sole Proprietor
Yes
Enumeration Date
2/4/2021
Last Updated
2/4/2021

Contact Information

Practice Location

1155 E 221st St, Bronx, NY 10469-1505

Unlisted Fax

Mailing Location

1155 E 221st St, Bronx, NY 10469-1505

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 163W00000X Primary	Description Registered Nurse Nursing Service Providers	License 751579-1 New York