Provider Demographics
NPI:1265487045
Name:FAMILY CARE NURSE PRACTITIONER, P.C.
Entity Type:Organization
Organization Name:FAMILY CARE NURSE PRACTITIONER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:518-399-0200
Mailing Address - Street 1:123 SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-4181
Mailing Address - Country:US
Mailing Address - Phone:518-399-0200
Mailing Address - Fax:518-399-4517
Practice Address - Street 1:123 SARATOGA RD
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-4181
Practice Address - Country:US
Practice Address - Phone:518-399-0200
Practice Address - Fax:518-399-4517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331148363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1235Medicare ID - Type UnspecifiedMEDICARE GROUP #