Provider Demographics
NPI:1578670741
Name:TITA, MAUREEN ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:ANN
Last Name:TITA
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:111 SEVENTH STREET
Mailing Address - Street 2:SUITE 111
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-639-1787
Mailing Address - Fax:516-594-5019
Practice Address - Street 1:111 SEVENTH STREET
Practice Address - Street 2:SUITE 111
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-639-1787
Practice Address - Fax:516-594-5019
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF401075363LP0808X
NY340084-1163WP0808X
NY401075363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01666971Medicaid