Healthcare Provider Details

I. General information

NPI: 1962337741
Provider Name (Legal Business Name): CHRISTINA DUVERGER ENCARNACION FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 FOOTPRINT CIR
LIVERPOOL NY
13088-4365
US

IV. Provider business mailing address

102 FOOTPRINT CIR
LIVERPOOL NY
13088-4365
US

V. Phone/Fax

Practice location:
  • Phone: 347-466-2106
  • Fax:
Mailing address:
  • Phone: 347-466-2106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06260102
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: