Provider Demographics
NPI:1720784879
Name:CHERISME JUSTAFORT, ANNE (FNP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:CHERISME JUSTAFORT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:CHERISME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1934 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3430
Mailing Address - Country:US
Mailing Address - Phone:347-451-1865
Mailing Address - Fax:
Practice Address - Street 1:1934 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3430
Practice Address - Country:US
Practice Address - Phone:347-451-1865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY785488163W00000X
NY351221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse