Healthcare Provider Details

I. General information

NPI: 1053885145
Provider Name (Legal Business Name): MARIA FRANCIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 E 86TH ST OFC 4C
NEW YORK NY
10028-0517
US

IV. Provider business mailing address

1500 ROUTE 112 STE 101
PORT JEFFERSON STATION NY
11776-8054
US

V. Phone/Fax

Practice location:
  • Phone: 212-861-6660
  • Fax: 631-751-0506
Mailing address:
  • Phone: 631-751-3000
  • Fax: 631-751-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11000159
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344151
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: