Healthcare Provider Details

I. General information

NPI: 1891725404
Provider Name (Legal Business Name): LINDA J ROBERTSON APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 BELLMORE AVE
N. BELLMORE NY
11710
US

IV. Provider business mailing address

1918 BELLMORE AVE
N. BELLMORE NY
11710
US

V. Phone/Fax

Practice location:
  • Phone: 516-316-2637
  • Fax: 516-486-2970
Mailing address:
  • Phone: 516-316-2637
  • Fax: 516-486-2970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400811-0
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberF400811-0
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: