Healthcare Provider Details

I. General information

NPI: 1508391871
Provider Name (Legal Business Name): NANCY WINTERS PHD, RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 STRATFORD LN
RIDGE NY
11961-2038
US

IV. Provider business mailing address

539 STRATFORD LN
RIDGE NY
11961-2038
US

V. Phone/Fax

Practice location:
  • Phone: 631-913-8702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF346481-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: