Provider Demographics
NPI:1417265018
Name:RATTAZZI, THERESA FITZGERALD (RN,BSN,MS,FNP)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:FITZGERALD
Last Name:RATTAZZI
Suffix:
Gender:F
Credentials:RN,BSN,MS,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 STATE ROUTE 208
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-1608
Mailing Address - Country:US
Mailing Address - Phone:845-783-6699
Mailing Address - Fax:845-783-7641
Practice Address - Street 1:505 STATE ROUTE 208
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-1608
Practice Address - Country:US
Practice Address - Phone:845-783-6699
Practice Address - Fax:845-783-7641
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336482363LF0000X
NJ26NJ00314400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily