Provider Demographics
NPI:1619218948
Name:EYTLE-ADAMS, AGNES CHRISTINA (FNP)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:CHRISTINA
Last Name:EYTLE-ADAMS
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 1:75 BROAD ST
Mailing Address - Street 2:SUITE 0815
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-2415
Mailing Address - Country:US
Mailing Address - Phone:347-761-3175
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:347-761-3175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334537363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY334537OtherLICENSE #