Provider Demographics
NPI:1215198064
Name:NIGHTENGALE, CAROL D (FNP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:D
Last Name:NIGHTENGALE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 ACADEMY ST
Mailing Address - Street 2:AFTON SCHOOL
Mailing Address - City:AFTON
Mailing Address - State:NY
Mailing Address - Zip Code:13730
Mailing Address - Country:US
Mailing Address - Phone:307-639-8224
Mailing Address - Fax:607-639-8257
Practice Address - Street 1:29 ACADEMY STREET
Practice Address - Street 2:AFTON SCHOOL
Practice Address - City:AFTON
Practice Address - State:NY
Practice Address - Zip Code:13730
Practice Address - Country:US
Practice Address - Phone:607-639-8224
Practice Address - Fax:607-639-8257
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332798363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily