Provider Demographics
NPI:1639609647
Name:INNOCENT, NADINE (FNP)
Entity Type:Individual
Prefix:MS
First Name:NADINE
Middle Name:
Last Name:INNOCENT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:NADINE
Other - Middle Name:
Other - Last Name:INNOCENT-SANTOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:354 E 53RD ST APT 4G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-4426
Mailing Address - Country:US
Mailing Address - Phone:347-567-1001
Mailing Address - Fax:
Practice Address - Street 1:4802 10TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2916
Practice Address - Country:US
Practice Address - Phone:718-283-7910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily