Individual
ALICIA A TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ANP-C, PMHNP-BC
Contact information
Practice address
775 PARK AVE STE 154, HUNTINGTON, NY 11743-5162
(631) 427-1100
Mailing address
1 BABYLON TPKE UNIT 359, ROOSEVELT, NY 11575-4025
(516) 642-5643
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
F305236-1
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402781
NY
Other
Enumeration date
05/19/2012
Last updated
07/10/2023
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