MEDICARE: AIMEE TAPIA AGUSTIN

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	F346520-01	NY

General Provider Information

NPI Number	:	1457997876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIMEE TAPIA AGUSTIN

Provider Business Mailing Address
First Line	:	5801 WOODSIDE AVE
Second Line	:	STE 2
City	:	WOODSIDE
State	:	NY
Zip	:	11377-3437
Country	:	US
Telephone Number	:	585-857-8709
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 COULTER RD STE 2610
Second Line	:
City	:	CLIFTON SPRINGS
State	:	NY
Zip	:	14432-1122
Country	:	US
Telephone Number	:	315-462-6500
Fax Number	:

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

Provider Enumeration Date	:	11/20/2019
Last Update Date	:	08/20/2021

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