Provider Demographics
NPI:1790572253
Name:HABIB, AZERINA (FNP)
Entity type:Individual
Prefix:
First Name:AZERINA
Middle Name:
Last Name:HABIB
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 1:5407 QUAMBY RD
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-6925
Mailing Address - Country:US
Mailing Address - Phone:315-269-0058
Mailing Address - Fax:
Practice Address - Street 1:5218 PATRICK RD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NY
Practice Address - Zip Code:13478-3012
Practice Address - Country:US
Practice Address - Phone:315-771-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF356509-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily