Healthcare Provider Details

I. General information

NPI: 1124917216
Provider Name (Legal Business Name): TRISTEN NICOLE KUZNESOFF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRISTEN NICOLE MARENGA RN

II. Dates (important events)

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

III. Provider practice location address

950 S OYSTER BAY RD
HICKSVILLE NY
11801-3511
US

IV. Provider business mailing address

950 S OYSTER BAY RD
HICKSVILLE NY
11801-3511
US

V. Phone/Fax

Practice location:
  • Phone: 631-637-5342
  • Fax:
Mailing address:
  • Phone: 631-637-5342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number848826
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: