Provider Demographics
NPI:1417363003
Name:KHACHATRYAN, FLORMESA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:FLORMESA
Middle Name:
Last Name:KHACHATRYAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:FLORMESA
Other - Middle Name:
Other - Last Name:SERQUINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:550 1ST AVE
Mailing Address - Street 2:NBV 5E5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:212-562-4000
Mailing Address - Fax:
Practice Address - Street 1:550 1ST AVE
Practice Address - Street 2:NBV 5E5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-562-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338484-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily