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Organization
ITAV-NURSE PRACTITIONER FAMILY HEALTH PLLC
Active
Organization
ITAV-NURSE PRACTITIONER FAMILY HEALTH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIA KNIGHT-FORBES (OWNER)
(631) 926-3025
Entity
Organization
Contact information
Practice address
455 ALBANY AVE UNIT C, AMITYVILLE, NY 11701-1193
(631) 926-3025
Mailing address
455 ALBANY AVE UNIT C, AMITYVILLE, NY 11701-1193
(631) 926-3025
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04391640
—
NY
Enumeration date
10/07/2019
Last updated
02/18/2021
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