Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Nicole Russo

Individual provider Family Nurse Practitioner · NPI 1629831235

Nicole Russo is a Nurse Practitioner in Whitestone, New York. Qualified in 2024, 2 years ago. Licensed in New York.

Years since qualifying
2
Licensed in
NY
In the registry since
2024
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Practice location Address checks out

14919 17th Ave
Whitestone, NY 11357-2539
Phone: (929) 428-0101
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence F353455-01 (NY)

Record details

NPI number1629831235
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedFebruary 5, 2024
Last updated in NPPESDecember 4, 2024
Certification dateDecember 4, 2024
Mailing address14919 17th Ave, Whitestone, NY 11357-2539

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Whitestone