Healthcare Provider Details

I. General information

NPI: 1962932228
Provider Name (Legal Business Name): REBECCA ANNE ARENA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA ANNE TROYANO

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SYLVAN AVE
MILLER PLACE NY
11764-2420
US

IV. Provider business mailing address

111 SYLVAN AVE
MILLER PLACE NY
11764-2420
US

V. Phone/Fax

Practice location:
  • Phone: 631-928-4888
  • Fax:
Mailing address:
  • Phone: 631-928-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number345471
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number718328-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: