Provider Demographics
NPI:1659986701
Name:DIFO, YVETTE ROSEMARY (FNP)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:ROSEMARY
Last Name:DIFO
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 1:3400 PAUL AVE APT 20H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1015
Mailing Address - Country:US
Mailing Address - Phone:646-633-7561
Mailing Address - Fax:
Practice Address - Street 1:565 W 235TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1650
Practice Address - Country:US
Practice Address - Phone:646-633-7561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346623363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily