Provider Demographics
NPI:1558952879
Name:NUGENT, ALEXANDRA (FNP-BC)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:NUGENT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 WYCKOFF ST APT 3R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6367
Mailing Address - Country:US
Mailing Address - Phone:732-865-5473
Mailing Address - Fax:
Practice Address - Street 1:155 SPRING ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-5208
Practice Address - Country:US
Practice Address - Phone:212-343-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY740066163W00000X
NY347453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse