MEDICARE: NICOLETTE CERBONE FNP

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	357128	NY

General Provider Information

NPI Number	:	1669360814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLETTE CERBONE FNP

Provider Business Mailing Address
First Line	:	1894 WALTON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-6018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	78 TODT HILL RD STE 205
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-4528
Country	:	US
Telephone Number	:	718-447-0781
Fax Number	:

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

Provider Enumeration Date	:	06/26/2025
Last Update Date	:	04/06/2026

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