Provider Demographics
NPI:1922402379
Name:NICOLE FRONTERA FAMILY HEALTH NURSE PRACTITIONER, PLLC
Entity Type:Organization
Organization Name:NICOLE FRONTERA FAMILY HEALTH NURSE PRACTITIONER, PLLC
Other - Org Name:NICOLE FRONTERA BEAUTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRONTERA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:718-945-1100
Mailing Address - Street 1:10402 ROCKAWAY BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2744
Mailing Address - Country:US
Mailing Address - Phone:178-945-1100
Mailing Address - Fax:718-945-1108
Practice Address - Street 1:173 BEACH 140TH ST
Practice Address - Street 2:
Practice Address - City:BELLE HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11694-1219
Practice Address - Country:US
Practice Address - Phone:347-967-7739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337740261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care