Provider Demographics
NPI:1184011892
Name:GRACELIFE FAMILY HEALTH NP PC
Entity Type:Organization
Organization Name:GRACELIFE FAMILY HEALTH NP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCA
Authorized Official - Middle Name:
Authorized Official - Last Name:NJOKU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:646-330-8918
Mailing Address - Street 1:4027 AMUNDSON AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2330
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4027 AMUNDSON AVE FL 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2330
Practice Address - Country:US
Practice Address - Phone:646-330-8918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
NY338352314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care