Healthcare Provider Details

I. General information

NPI: 1952934515
Provider Name (Legal Business Name): TEZRA WHITE FNP-BC, PMHNP - BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 LORIMER ST STE D5055
BROOKLYN NY
11206-1030
US

IV. Provider business mailing address

442 LORIMER ST STE D5055
BROOKLYN NY
11206-1030
US

V. Phone/Fax

Practice location:
  • Phone: 516-453-0721
  • Fax:
Mailing address:
  • Phone: 516-453-0721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404859
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF345260-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: