Provider Demographics
NPI:1629383203
Name:GARNICA, PATRICIA (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GARNICA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 SAINT NICHOLAS AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3822
Mailing Address - Country:US
Mailing Address - Phone:212-305-7838
Mailing Address - Fax:212-851-5485
Practice Address - Street 1:1150 SAINT NICHOLAS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3822
Practice Address - Country:US
Practice Address - Phone:212-305-7838
Practice Address - Fax:212-851-5485
Is Sole Proprietor?:No
Enumeration Date:2010-08-08
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305377-1363LA2200X
NY423137-1163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400045153OtherMEDICARE ID
NY03322929Medicaid