Provider Demographics
NPI:1306554027
Name:CARDONA, CARINNE NICOLE (FNP)
Entity type:Individual
Prefix:MS
First Name:CARINNE
Middle Name:NICOLE
Last Name:CARDONA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-3156
Mailing Address - Country:US
Mailing Address - Phone:917-715-5818
Mailing Address - Fax:
Practice Address - Street 1:650 HAWKINS AVE STE 7
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-2366
Practice Address - Country:US
Practice Address - Phone:631-737-0055
Practice Address - Fax:631-737-0076
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349903363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily