Provider Demographics
NPI:1326593864
Name:ADALLA-ANGELES, KRISTINE JAYE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE JAYE
Middle Name:
Last Name:ADALLA-ANGELES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KRISTINE JAYE
Other - Middle Name:YUZON
Other - Last Name:ADALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:229 7TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5766
Mailing Address - Country:US
Mailing Address - Phone:516-747-7778
Mailing Address - Fax:
Practice Address - Street 1:229 7TH ST STE 105
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5766
Practice Address - Country:US
Practice Address - Phone:516-747-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY627159163W00000X
NY349366363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse