Provider Demographics
NPI:1316393051
Name:MOWASSEE, RICARDO (FNP)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:MOWASSEE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 FOSTER AVE, SUITE B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2134
Mailing Address - Country:US
Mailing Address - Phone:718-854-3005
Mailing Address - Fax:718-854-9803
Practice Address - Street 1:198 FOSTER AVE, SUITE B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2134
Practice Address - Country:US
Practice Address - Phone:718-854-3005
Practice Address - Fax:718-854-9803
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily