Healthcare Provider Details

I. General information

NPI: 1922357144
Provider Name (Legal Business Name): AUDRY M OLTHOFF FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUDRY M OLTHOFF NP

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MONTAUK HWY
SOUTHAMPTON NY
11968-4137
US

IV. Provider business mailing address

2 MONTAUK HWY
SOUTHAMPTON NY
11968-4137
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-7891
  • Fax:
Mailing address:
  • Phone: 646-962-7891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number553289-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343036
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: