MEDICARE: NICOLE FRONTERA FAMILY HEALTH NURSE PRACTITIONER, PLLC

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	261QP2300X	Primary Care Clinic/Center	F337740	NY

General Provider Information

NPI Number	:	1922402379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICOLE FRONTERA FAMILY HEALTH NURSE PRACTITIONER, PLLC

Provider Business Mailing Address
First Line	:	10402 ROCKAWAY BEACH BLVD
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2744
Country	:	US
Telephone Number	:	178-945-1100
Fax Number	:	718-945-1108

Provider Business Practice Location Address
First Line	:	173 BEACH 140TH ST
Second Line	:
City	:	BELLE HARBOR
State	:	NY
Zip	:	11694-1219
Country	:	US
Telephone Number	:	347-967-7739
Fax Number	:

Authorized Official
Title or Position	:	FAMILY NURSE PRACTITIONER
Name	:	MRS. NICOLE FRONTERA
Credential	:	FNP
Telephone Number	:	718-945-1100

Provider Enumeration Date	:	10/14/2014
Last Update Date	:	10/14/2014

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