Healthcare Provider Details

I. General information

NPI: 1013685551
Provider Name (Legal Business Name): ANGELICA DZIEKAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PRINCE LN
WESTBURY NY
11590-6228
US

IV. Provider business mailing address

5 PRINCE LN
WESTBURY NY
11590-6228
US

V. Phone/Fax

Practice location:
  • Phone: 646-895-0419
  • Fax:
Mailing address:
  • Phone: 646-895-0419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF360344-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number776939
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: