Provider Demographics
NPI:1750087144
Name:FUZAILOVA, TZIPORA HAIMOV (FNP)
Entity type:Individual
Prefix:
First Name:TZIPORA
Middle Name:HAIMOV
Last Name:FUZAILOVA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 OLD COUNTRY RD UNIT 1156A
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3609
Mailing Address - Country:US
Mailing Address - Phone:917-500-3016
Mailing Address - Fax:
Practice Address - Street 1:729 ELMONT RD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4035
Practice Address - Country:US
Practice Address - Phone:917-500-3016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF351274-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily