Provider Demographics
NPI:1649522756
Name:KAPSAROFF-RUIZ, NATASHA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:
Last Name:KAPSAROFF-RUIZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 WATERVLIET SHAKER RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110
Mailing Address - Country:US
Mailing Address - Phone:518-218-4455
Mailing Address - Fax:518-380-2023
Practice Address - Street 1:654 WATERVLIET SHAKER RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110
Practice Address - Country:US
Practice Address - Phone:518-218-4455
Practice Address - Fax:518-380-2023
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238335363LF0000X
NY337390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily