Provider Demographics
NPI:1053876409
Name:AMPOFO, PRISCILLA ISABELLA (FNP)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:ISABELLA
Last Name:AMPOFO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:ISABELLA
Other - Last Name:AMPOFO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:111 HOLLISTER ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-6230
Mailing Address - Country:US
Mailing Address - Phone:718-300-5978
Mailing Address - Fax:
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:212-639-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily