Healthcare Provider Details

I. General information

NPI: 1336821289
Provider Name (Legal Business Name): SHARISSA PETIT-FRERE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 ELIZABETH AVE
ELIZABETH NJ
07201-2200
US

IV. Provider business mailing address

114 WASHINGTON AVE
ELIZABETH NJ
07202-3409
US

V. Phone/Fax

Practice location:
  • Phone: 908-351-5384
  • Fax:
Mailing address:
  • Phone: 908-447-3824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ14872900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number352115
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: