Healthcare Provider Details

I. General information

NPI: 1629693973
Provider Name (Legal Business Name): ELAINA HUFNAGEL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SARAH DR
HAUPPAUGE NY
11788-2634
US

IV. Provider business mailing address

1 SARAH DR
HAUPPAUGE NY
11788-2634
US

V. Phone/Fax

Practice location:
  • Phone: 516-551-5938
  • Fax:
Mailing address:
  • Phone: 516-551-5938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0300X
TaxonomyNephrology Registered Nurse
License Number445523
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346407
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: