Provider Demographics
NPI:1659489805
Name:YAX, KAREN ELIZABETH (FNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ELIZABETH
Last Name:YAX
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9058 LUCKENBACH HILL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGWATER
Mailing Address - State:NY
Mailing Address - Zip Code:14560-9646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 HONEOYE COMMONS
Practice Address - Street 2:
Practice Address - City:HONEOYE
Practice Address - State:NY
Practice Address - Zip Code:14471
Practice Address - Country:US
Practice Address - Phone:585-229-2215
Practice Address - Fax:585-229-2210
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331827363LF0000X
NYF331827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP019331827OtherEXCELLUS
NY109170BFOtherPREFERRED CARE
NYCC5271Medicare ID - Type Unspecified