Provider Demographics
NPI:1083589741
Name:PLACENCIA FAMILY HEALTH NURSE PRACTITIONER PLLC
Entity type:Organization
Organization Name:PLACENCIA FAMILY HEALTH NURSE PRACTITIONER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITZY
Authorized Official - Middle Name:
Authorized Official - Last Name:PLACENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:347-419-5377
Mailing Address - Street 1:300 WINSTON DR APT 906
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3215
Mailing Address - Country:US
Mailing Address - Phone:347-674-3635
Mailing Address - Fax:
Practice Address - Street 1:240 W 37TH ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-5787
Practice Address - Country:US
Practice Address - Phone:347-674-3635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty