Provider Demographics
NPI:1174967152
Name:THERMIDOR, ANNIE TAYINAH (NP)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:TAYINAH
Last Name:THERMIDOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 LENOX RD
Mailing Address - Street 2:2Z
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2179
Mailing Address - Country:US
Mailing Address - Phone:347-489-9409
Mailing Address - Fax:
Practice Address - Street 1:222 LENOX RD
Practice Address - Street 2:2Z
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-2179
Practice Address - Country:US
Practice Address - Phone:347-489-9409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF4306841363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care