Individual provider Active NPI

Tatyana Kateva, FNP-BC

  • Family Nurse Practitioner
  • Staten Island, NY
National Provider Identifier
1124498407
Registry record updated Sep 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
339336 Issued in NY
Practice address
1975 Hylan Blvd Suite 1
Staten Island, NY 10306
Phone
(718) 954-2202
NPI assigned
Sep 30, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 639733 NY
Family Nurse Practitioner 363LF0000X 339336 NY Primary

Addresses

Primary practice location

1975 Hylan Blvd Suite 1
Staten Island, NY 10306

Mailing address

30 Ebbitts St Apt 3G
Staten Island, NY 10306-4821
Phone (718) 987-5352

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221102003551 FL Practitioner - Nurse Practitioner 5092015784 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
639733NYMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Longevity Clinical LTC Associates of Florida PLLC CurrentSince Sep 13, 2022 Accepting new patients
Longevity Accountable Care, PA CurrentSince Feb 10, 2026 Accepting new patients
Longevity Accountable Care, PA CurrentSince Feb 10, 2026 Accepting new patients

Locations

4300 Rock Island Rd
Lauderhill, FL 33319
Phone (954) 309-1126

1404 NW 22nd St
Miami, FL 33142
Phone (305) 325-1050

11770 US Highway 1
Ste 102E
Palm Beach Gardens, FL 33408
Phone 56181524270

2939 S Haverhill Rd
West Palm Beach, FL 33415
Phone (561) 641-3130

2970 Scarlet Rd
Winter Park, FL 32792
Phone (350) 250-2435

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1443571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443571200000",
    "number": "1124498407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 EBBITTS ST APT 3G",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103064821",
            "telephone_number": "718-987-5352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 HYLAN BLVD SUITE 1",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10306",
            "telephone_number": "718-954-2202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KATEVA",
        "first_name": "TATYANA",
        "name_prefix": "Ms.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-30",
        "last_updated": "2015-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "639733",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "339336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.