MEDICARE: DIANE ABIOLA SIMPSON DASENT NURSE PRACTITIONER

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	363LP2300X	Primary Care Nurse Practitioner	F343289-1	NY

General Provider Information

NPI Number	:	1205465655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE ABIOLA SIMPSON DASENT NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	135 MINEOLA BLVD FL 2
Second Line	:
City	:	MINEOLA
State	:	NY
Zip	:	11501-3917
Country	:	US
Telephone Number	:	917-410-6990
Fax Number	:	516-938-1554

Provider Business Practice Location Address
First Line	:	8010 NORTHERN BLVD STE A
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1345
Country	:	US
Telephone Number	:	917-310-3371
Fax Number	:	516-938-1554

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

Provider Enumeration Date	:	04/07/2020
Last Update Date	:	12/12/2025

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