Healthcare Provider Details

I. General information

NPI: 1467252395
Provider Name (Legal Business Name): JOUDLIE JEAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOUDLIE JEAN

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 09/14/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 UNIVERSITY PLZ STE 204
HACKENSACK NJ
07601-6211
US

IV. Provider business mailing address

2 UNIVERSITY PLZ STE 204
HACKENSACK NJ
07601-6211
US

V. Phone/Fax

Practice location:
  • Phone: 551-295-8223
  • Fax:
Mailing address:
  • Phone: 551-295-8223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15297500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: