Healthcare Provider Details

I. General information

NPI: 1881339968
Provider Name (Legal Business Name): JOCELYN HLAVAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 FRANKLIN AVE
BRONX NY
10456-3501
US

IV. Provider business mailing address

1276 FULTON AVE
BRONX NY
10456-3402
US

V. Phone/Fax

Practice location:
  • Phone: 718-992-7669
  • Fax:
Mailing address:
  • Phone: 718-992-7669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404018
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: