Provider Demographics
NPI:1760055602
Name:CORDOVA-HAYES, ANGELITA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:ANGELITA
Middle Name:
Last Name:CORDOVA-HAYES
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 FEATHERBED LN APT 6H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-1680
Mailing Address - Country:US
Mailing Address - Phone:917-833-9481
Mailing Address - Fax:
Practice Address - Street 1:8268 164TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1104
Practice Address - Country:US
Practice Address - Phone:718-883-2954
Practice Address - Fax:718-883-6328
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403537363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health