Individual provider Active NPI

Marianna Nikolenko, FNP

  • Family Nurse Practitioner
  • Staten Island, NY
National Provider Identifier
1649906512
Registry record updated Feb 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
349961 Issued in NY
Practice address
14 Purdy PL
Staten Island, NY 10309-4052
Phone
(917) 438-8700
NPI assigned
Jul 25, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 349961 NY Primary

Addresses

Primary practice location

14 Purdy PL
Staten Island, NY 10309-4052

Mailing address

14 Purdy PL
Staten Island, NY 10309-4052
Phone (917) 438-8700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
349961NYMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1658707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676764800000",
    "number": "1649906512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 PURDY PL",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103094052",
            "telephone_number": "917-438-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 PURDY PL",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103094052",
            "telephone_number": "917-438-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIKOLENKO",
        "first_name": "MARIANNA",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-25",
        "last_updated": "2023-02-19",
        "certification_date": "2023-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "349961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.