Provider Demographics
NPI:1518013804
Name:NACARIO, ANITA MIMI C (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:ANITA MIMI
Middle Name:C
Last Name:NACARIO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CHAUCER ST
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1055
Mailing Address - Country:US
Mailing Address - Phone:914-993-0737
Mailing Address - Fax:718-960-5726
Practice Address - Street 1:55 CHAUCER ST
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1055
Practice Address - Country:US
Practice Address - Phone:914-993-0737
Practice Address - Fax:718-960-5726
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302249363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP54077Medicare UPIN
NY2E5951Medicare ID - Type Unspecified