Basic Information
| Provider Information | |||||||||
| NPI: | 1619361060 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | HERMINA | ||||||||
| MiddleName: | BARBARA ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 SELWYN AVE | ||||||||
| Address2: | 10TH FLOOR | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104577626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189601234 | ||||||||
| FaxNumber: | 7189602055 | ||||||||
| Practice Location | |||||||||
| Address1: | 1650 SELWYN AVE | ||||||||
| Address2: | 10TH FLOOR | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104577626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189601234 | ||||||||
| FaxNumber: | 7189602055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2015 | ||||||||
| LastUpdateDate: | 10/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 592943-1 | NY | N | Nursing Service Providers | Registered Nurse | 363LF0000X | F339114-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.