Provider Demographics
NPI:1336324128
Name:FRANCIS, NADINE CAMILLA
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:CAMILLA
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SAINT JOHNS PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2533
Mailing Address - Country:US
Mailing Address - Phone:718-953-7150
Mailing Address - Fax:
Practice Address - Street 1:1040 SAINT JOHNS PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2533
Practice Address - Country:US
Practice Address - Phone:718-953-7150
Practice Address - Fax:718-778-8467
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01589197Medicaid