Healthcare Provider Details

I. General information

NPI: 1285869586
Provider Name (Legal Business Name): JAMIE LEA PLATA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2009
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W JIMMIE LEEDS RD
GALLOWAY NJ
08205-9421
US

IV. Provider business mailing address

203 ROUTE 50
OCEAN VIEW NJ
08230-1231
US

V. Phone/Fax

Practice location:
  • Phone: 609-710-5530
  • Fax:
Mailing address:
  • Phone: 609-827-0157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15575600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR19455500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: