Provider Demographics
NPI:1871922674
Name:SPIRIO, JENNIFER (ANP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:SPIRIO
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BOWMAN LN
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2007
Mailing Address - Country:US
Mailing Address - Phone:631-265-2353
Mailing Address - Fax:
Practice Address - Street 1:75 BROAD ST
Practice Address - Street 2:SUITE 0815
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2415
Practice Address - Country:US
Practice Address - Phone:718-391-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301171-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health