Provider Demographics
NPI:1043684848
Name:FERGUSON, PATRICE ALLISON (FNP)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:ALLISON
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 NORFELD BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3640
Mailing Address - Country:US
Mailing Address - Phone:516-352-3821
Mailing Address - Fax:
Practice Address - Street 1:232 NORFELD BLVD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3640
Practice Address - Country:US
Practice Address - Phone:516-352-3821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339011-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily