Healthcare Provider Details

I. General information

NPI: 1841841616
Provider Name (Legal Business Name): IRINA ROKUN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 CROPSEY AVE
BROOKLYN NY
11214-6800
US

IV. Provider business mailing address

8814 BAY PKWY APT 6C
BROOKLYN NY
11214-5627
US

V. Phone/Fax

Practice location:
  • Phone: 347-891-2200
  • Fax:
Mailing address:
  • Phone: 347-891-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number675735
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344883
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: