Provider Demographics
NPI:1063921922
Name:FEAFEA MOORE PEAL NURSE PRACTITIONER IN FAMILY HEALTH PLLC
Entity type:Organization
Organization Name:FEAFEA MOORE PEAL NURSE PRACTITIONER IN FAMILY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FEAFEA
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:PEAL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:347-858-2497
Mailing Address - Street 1:14507 130TH AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11436-2234
Mailing Address - Country:US
Mailing Address - Phone:718-529-1648
Mailing Address - Fax:
Practice Address - Street 1:14507 130TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11436-2234
Practice Address - Country:US
Practice Address - Phone:718-529-1648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337511363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty