Provider Demographics
NPI:1013493337
Name:FLANDINA, NICOLE LYNN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LYNN
Last Name:FLANDINA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:CASANOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:20 GLIDE LN
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2206
Mailing Address - Country:US
Mailing Address - Phone:631-741-7715
Mailing Address - Fax:
Practice Address - Street 1:402 POTTER BLVD
Practice Address - Street 2:
Practice Address - City:BRIGHTWATERS
Practice Address - State:NY
Practice Address - Zip Code:11718-1830
Practice Address - Country:US
Practice Address - Phone:631-894-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF343359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty