Provider Demographics
NPI:1285129841
Name:EDUCATE, GINA (NP)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:EDUCATE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:MARCANTONIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2209 GENESEE STREET
Mailing Address - Street 2:BUSINESS OFFICE -ROOM 315
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5930
Mailing Address - Country:US
Mailing Address - Phone:315-801-3282
Mailing Address - Fax:315-801-8391
Practice Address - Street 1:1658 CHAMPLIN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502
Practice Address - Country:US
Practice Address - Phone:315-624-4915
Practice Address - Fax:315-624-8310
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0208206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05212560Medicaid