MEDICARE: SOFIA TOFIGA GAMIDOVA APN-C

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	F306399	NY

General Provider Information

NPI Number	:	1326481276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOFIA TOFIGA GAMIDOVA APN-C

Provider Business Mailing Address
First Line	:	2970 OCEAN AVE
Second Line	:	APT G5
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3276
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1961 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-2328
Country	:	US
Telephone Number	:	718-339-6425
Fax Number	:

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

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	08/10/2017

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