Provider Demographics
NPI:1285428086
Name:BAJRAKTAREVIC, MERISA (FNP)
Entity type:Individual
Prefix:MRS
First Name:MERISA
Middle Name:
Last Name:BAJRAKTAREVIC
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 LIVERMORE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2503
Mailing Address - Country:US
Mailing Address - Phone:917-960-0051
Mailing Address - Fax:
Practice Address - Street 1:54 LIVERMORE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2503
Practice Address - Country:US
Practice Address - Phone:917-960-0051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY356519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily