Provider Demographics
NPI:1013231703
Name:HIDALGO, LAURITA (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:LAURITA
Middle Name:
Last Name:HIDALGO
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3416 34TH ST
Mailing Address - Street 2:APT 3F
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3416 34TH ST
Practice Address - Street 2:APT 3F
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-1211
Practice Address - Country:US
Practice Address - Phone:212-241-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY43430484363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care