Provider Demographics
NPI:1093000234
Name:FERRARA, KRISTIN (RN, NNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:FERRARA
Suffix:
Gender:F
Credentials:RN, NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 MILLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3728
Mailing Address - Country:US
Mailing Address - Phone:631-902-1768
Mailing Address - Fax:
Practice Address - Street 1:101 NICOLLS RD DEPT OF
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794
Practice Address - Country:US
Practice Address - Phone:631-444-2710
Practice Address - Fax:631-444-7865
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY602767-1163WN0002X
NYF350324-1363LN0005X, 363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care