Provider Demographics
NPI:1306014998
Name:HOOVER, AUDREY PAMELLA (FNP)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:PAMELLA
Last Name:HOOVER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:940 GRAND CONCOURSE
Mailing Address - Street 2:#5K
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-2724
Mailing Address - Country:US
Mailing Address - Phone:646-541-4765
Mailing Address - Fax:
Practice Address - Street 1:41 PARK ROW
Practice Address - Street 2:STE. 313
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-1508
Practice Address - Country:US
Practice Address - Phone:212-346-1600
Practice Address - Fax:212-346-1308
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331735-1363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY94N841OtherMEDICARE
NY94N841OtherMEDICARE