Healthcare Provider Details

I. General information

NPI: 1851106827
Provider Name (Legal Business Name): NIURKA FERNANDEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N PORTLAND AVE
BROOKLYN NY
11205-2005
US

IV. Provider business mailing address

100 N PORTLAND AVE
BROOKLYN NY
11205-2005
US

V. Phone/Fax

Practice location:
  • Phone: 844-692-4692
  • Fax: 718-260-7730
Mailing address:
  • Phone: 844-692-4692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF355407
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF35540701
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: