MEDICARE: TEZRA WHITE FNP-BC, PMHNP - BC

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	363LF0000X	Family Nurse Practitioner	F345260-01	NY

General Provider Information

NPI Number	:	1952934515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEZRA WHITE FNP-BC, PMHNP - BC

Provider Business Mailing Address
First Line	:	442 LORIMER ST STE D5055
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-1030
Country	:	US
Telephone Number	:	516-453-0721
Fax Number	:

Provider Business Practice Location Address
First Line	:	442 LORIMER ST STE D5055
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-1030
Country	:	US
Telephone Number	:	516-453-0721
Fax Number	:

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

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	03/12/2026

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