Provider Demographics
NPI:1073879441
Name:DUFFY, AUDREY (FNP)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:DUFFY
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 1:2710 30TH AVE
Mailing Address - Street 2:#LA
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2401
Mailing Address - Country:US
Mailing Address - Phone:718-932-9870
Mailing Address - Fax:718-932-9878
Practice Address - Street 1:2710 30TH AVE
Practice Address - Street 2:#LA
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2401
Practice Address - Country:US
Practice Address - Phone:718-932-9870
Practice Address - Fax:718-932-9878
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330270-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health