Individual
MS. KRISTAN PROBECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MS, ANP
Contact information
Practice address
1743 NORTH OCEAN AVE, MEDFORD, NY 11763
(631) 758-3100
Mailing address
100 NICHOLLS RD, HSC 19-090 DEPARTMENT OF VASCULAR SURGERY, STONY BROOK, NY 11794-0001
(631) 444-5454
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
544021
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
30 305525
NY
Other
Enumeration date
05/17/2012
Last updated
03/01/2016
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