Provider Demographics
NPI:1588175798
Name:WARNER, NINA (NP)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:WARNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:WARNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:928 BROADWAY STE 301
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-8156
Mailing Address - Country:US
Mailing Address - Phone:631-557-3043
Mailing Address - Fax:
Practice Address - Street 1:524 MONTAUK HWY STE 101
Practice Address - Street 2:
Practice Address - City:AMAGANSETT
Practice Address - State:NY
Practice Address - Zip Code:11930-2110
Practice Address - Country:US
Practice Address - Phone:631-557-3043
Practice Address - Fax:631-557-3044
Is Sole Proprietor?:No
Enumeration Date:2017-10-15
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY722014163W00000X
NY348286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1588175798Medicaid