Provider Demographics
NPI:1174028799
Name:PETRUCCELLI, FILIPPA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:FILIPPA
Middle Name:
Last Name:PETRUCCELLI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 CENTRAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2030
Mailing Address - Country:US
Mailing Address - Phone:857-205-9747
Mailing Address - Fax:
Practice Address - Street 1:101 LAUREL RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1415
Practice Address - Country:US
Practice Address - Phone:631-930-9399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF30806601363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health