MEDICARE: MS. PATRICIA S NNAETUK AHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	F305133	NY
2	364SF0001X	Family Health Clinical Nurse Specialist	337421	NY

General Provider Information

NPI Number	:	1144544222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA S NNAETUK AHNP

Provider Business Mailing Address
First Line	:	1400 PELHAM PARKWAY SOUTH
Second Line	:	JACOBI MEDICAL CENTER
City	:	BRONX
State	:	NY
Zip	:	10461
Country	:	US
Telephone Number	:	718-918-6052
Fax Number	:	718-918-7701

Provider Business Practice Location Address
First Line	:	1400 PELHAM PKWY S BLDG 1
Second Line	:	JACOBI MEDICAL CENTER
City	:	BRONX
State	:	NY
Zip	:	10461-1119
Country	:	US
Telephone Number	:	718-918-6052
Fax Number	:	718-918-7701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2010
Last Update Date	:	02/27/2015

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