MEDICARE: NADYA BOLGOVA FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	347327	NY

General Provider Information

NPI Number	:	1255916797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADYA BOLGOVA FNP-BC

Provider Business Mailing Address
First Line	:	2885 W 12TH ST APT 8J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-3028
Country	:	US
Telephone Number	:	646-577-4709
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 STACK DR
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-1632
Country	:	US
Telephone Number	:	646-577-4709
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2021
Last Update Date	:	03/16/2021

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