Provider Demographics
NPI:1730905282
Name:NISIMOVA, BELLA (FNP)
Entity type:Individual
Prefix:
First Name:BELLA
Middle Name:
Last Name:NISIMOVA
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 1:1612 CENTRAL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4002
Mailing Address - Country:US
Mailing Address - Phone:718-840-3415
Mailing Address - Fax:347-474-8670
Practice Address - Street 1:1612 CENTRAL AVE STE 201
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4002
Practice Address - Country:US
Practice Address - Phone:718-840-3415
Practice Address - Fax:347-474-8670
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF353620-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily