Healthcare Provider Details

I. General information

NPI: 1619361060
Provider Name (Legal Business Name): HERMINA BARBARA ANN ROBERTS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SELWYN AVE 10TH FLOOR
BRONX NY
10457-7626
US

IV. Provider business mailing address

1650 SELWYN AVE 10TH FLOOR
BRONX NY
10457-7626
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-1234
  • Fax: 718-960-2055
Mailing address:
  • Phone: 718-960-1234
  • Fax: 718-960-2055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number592943-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF339114-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: