Provider Demographics
NPI:1619137452
Name:NAZAIRE, LETICIA (ANP)
Entity Type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:
Last Name:NAZAIRE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 EXPRESSWAY DRIVE NORTH
Mailing Address - Street 2:SUITE 200 B
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749
Mailing Address - Country:US
Mailing Address - Phone:631-444-3497
Mailing Address - Fax:631-444-1530
Practice Address - Street 1:3001 EXPRESSWAY DRIVE NORTH
Practice Address - Street 2:SUITE 200 B
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749
Practice Address - Country:US
Practice Address - Phone:631-444-3497
Practice Address - Fax:631-444-1530
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3036481363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health