Healthcare Provider Details

I. General information

NPI: 1467937169
Provider Name (Legal Business Name): ELIZABETH LAFARGUE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 UTICA AVE
BROOKLYN NY
11203-2230
US

IV. Provider business mailing address

520 BEACH 20TH ST
FAR ROCKAWAY NY
11691-3622
US

V. Phone/Fax

Practice location:
  • Phone: 850-299-0763
  • Fax:
Mailing address:
  • Phone:
  • Fax: 850-299-0763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343632
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: