Provider Demographics
NPI:1558509828
Name:D'AMBROSIA, DENISE FO (RN, FNP-C, PROF)
Entity type:Individual
Prefix:PROF
First Name:DENISE
Middle Name:FO
Last Name:D'AMBROSIA
Suffix:
Gender:F
Credentials:RN, FNP-C, PROF
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:47A SALLY LA
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-2429
Mailing Address - Country:US
Mailing Address - Phone:631-345-5198
Mailing Address - Fax:631-345-5198
Practice Address - Street 1:T16-020 HSC
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8171
Practice Address - Country:US
Practice Address - Phone:631-444-1062
Practice Address - Fax:631-444-1054
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332998-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily