Provider Demographics
NPI:1164976221
Name:JOHN, PRAISY (MS, FNP-BC, BS, RN)
Entity Type:Individual
Prefix:
First Name:PRAISY
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:MS, FNP-BC, BS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 CENTER BLVD
Mailing Address - Street 2:APT 3219
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5901
Mailing Address - Country:US
Mailing Address - Phone:240-920-9595
Mailing Address - Fax:
Practice Address - Street 1:4545 CENTER BLVD
Practice Address - Street 2:APT 3219
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11109-5901
Practice Address - Country:US
Practice Address - Phone:240-920-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-06
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340919-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily