Provider Demographics
NPI:1750024824
Name:CIARLETTA, KATHLEEN (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CIARLETTA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WHITNEY RD
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11709-2441
Mailing Address - Country:US
Mailing Address - Phone:516-641-4900
Mailing Address - Fax:
Practice Address - Street 1:12 WHITNEY RD
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11709-2441
Practice Address - Country:US
Practice Address - Phone:516-641-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily