Provider Demographics
NPI:1164644035
Name:NITTI, LYNN-MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:LYNN-MARIE
Middle Name:
Last Name:NITTI
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 1:63 MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-2502
Mailing Address - Country:US
Mailing Address - Phone:631-448-7800
Mailing Address - Fax:631-775-9296
Practice Address - Street 1:63 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-2502
Practice Address - Country:US
Practice Address - Phone:631-448-7800
Practice Address - Fax:631-775-9296
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330338363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY95V052OtherOLD MEDICARE NUMBER
NY01790707Medicaid
NYA400028136OtherMEDICARE
NYS84590Medicare UPIN