Healthcare Provider Details

I. General information

NPI: 1679001341
Provider Name (Legal Business Name): NELCIE ECCLESIASTRE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 BAY PKWY STE 901
BROOKLYN NY
11204-6081
US

IV. Provider business mailing address

6010 BAY PKWY STE 901
BROOKLYN NY
11204-6081
US

V. Phone/Fax

Practice location:
  • Phone: 718-238-2100
  • Fax: 718-748-0863
Mailing address:
  • Phone: 718-238-2100
  • Fax: 718-748-0863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3204882
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343935
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: