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General NPI Number Information
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NPI Number | 1740058635
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Entity Type | Individual
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Provider Name | NANCY ALTAGRACIA MATA FERMIN NP
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Gender | Female
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Dates
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Enumeration Date | 12/19/2023
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 436 FORT WASHINGTON AVE APT 1H
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City | NEW YORK
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State | NY
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Zip | 10033-3537
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Country | US
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Telephone | 347-293-3818
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Fax | 212-923-5531
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Provider Business Mailing Address
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Address Line | 29 ROSE AVE
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City | WESTBURY
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State | NY
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Zip | 11590-1027
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Country | US
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Telephone | 347-293-3818
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Fax | 212-923-5531
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F353217-01
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License Number State | NY
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