Provider Demographics
NPI:1134509136
Name:DESTINE-AZOR, MARIE SMITH (FNP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:SMITH
Last Name:DESTINE-AZOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:S
Other - Last Name:DESTINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:3110 MILBURN AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4453
Mailing Address - Country:US
Mailing Address - Phone:516-223-2331
Mailing Address - Fax:
Practice Address - Street 1:230 HILTON AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-8115
Practice Address - Country:US
Practice Address - Phone:516-254-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily