Healthcare Provider Details

I. General information

NPI: 1588014229
Provider Name (Legal Business Name): ROZELLE JASMINE DUKETTE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 BAINBRIDGE AVE 7TH FLOOR
BRONX NY
10467-2404
US

IV. Provider business mailing address

3400 BAINBRIDGE AVE 7TH FLOOR
BRONX NY
10467-2404
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-2626
  • Fax: 718-652-1833
Mailing address:
  • Phone: 718-920-2626
  • Fax: 718-652-1833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number339448
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: