Provider Demographics
NPI:1912568551
Name:SPENCE, CECILE (FNP)
Entity Type:Individual
Prefix:
First Name:CECILE
Middle Name:
Last Name:SPENCE
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 1:1594 CANARSIE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3059
Mailing Address - Country:US
Mailing Address - Phone:347-737-4254
Mailing Address - Fax:
Practice Address - Street 1:321 PENNSYLVANIA AVE STE 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-4101
Practice Address - Country:US
Practice Address - Phone:718-484-8985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348081363LF0000X
NY745109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily