Provider Demographics
NPI:1144879222
Name:SOUMAILA-BORKOVEC, FAKIRA (FNP-C)
Entity type:Individual
Prefix:
First Name:FAKIRA
Middle Name:
Last Name:SOUMAILA-BORKOVEC
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:FAKIRA
Other - Middle Name:
Other - Last Name:BORKOVEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1575 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-9371
Mailing Address - Country:US
Mailing Address - Phone:315-785-4155
Mailing Address - Fax:315-779-5066
Practice Address - Street 1:1575 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-9371
Practice Address - Country:US
Practice Address - Phone:315-785-4155
Practice Address - Fax:315-779-5066
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK148626363LF0000X
NY351629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily