Individual
JOHANIS THAMAR PATSIKOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
161 FORT WASHINGTON AVE, NEW YORK, NY 10032-3729
(212) 305-7340
(212) 305-6891
Mailing address
630 W 168TH ST # 4, NEW YORK, NY 10032-3725
(212) 305-7340
(212) 305-6891
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
677151
NY
363L00000X
Nurse Practitioner
F308049-1
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
F308049
NY
Other
Enumeration date
06/03/2014
Last updated
05/09/2019
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