MEDICARE: SAMRA MARKISIC NP

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	363LA2100X	Acute Care Nurse Practitioner	431362	NY

General Provider Information

NPI Number	:	1518445972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMRA MARKISIC NP

Provider Business Mailing Address
First Line	:	6 CONISTON CT
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2482
Country	:	US
Telephone Number	:	917-815-4275
Fax Number	:

Provider Business Practice Location Address
First Line	:	6817 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7267
Country	:	US
Telephone Number	:	718-873-1444
Fax Number	:	718-689-7365

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

Provider Enumeration Date	:	07/29/2018
Last Update Date	:	05/28/2026

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