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General NPI Number Information
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NPI Number | 1326308776
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Entity Type | Individual
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Provider Name | ALICIA A TATE ANP-C, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/19/2012
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 775 PARK AVE STE 154
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City | HUNTINGTON
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State | NY
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Zip | 11743-5162
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Country | US
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Telephone | 631-427-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 1 BABYLON TPKE UNIT 359
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City | ROOSEVELT
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State | NY
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Zip | 11575-4025
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Country | US
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Telephone | 516-642-5643
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F305236-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 402781
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License Number State | NY
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