Healthcare Provider Details

I. General information

NPI: 1336069541
Provider Name (Legal Business Name): JENNA TIMECA HONORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 BLUE POINT AVE
BLUE POINT NY
11715-1224
US

IV. Provider business mailing address

117 APPLEGATE DR
CENTRAL ISLIP NY
11722-1116
US

V. Phone/Fax

Practice location:
  • Phone: 631-419-6737
  • Fax: 631-868-3498
Mailing address:
  • Phone: 631-419-6737
  • Fax: 631-868-3498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberN37473-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: