Healthcare Provider Details

I. General information

NPI: 1013870914
Provider Name (Legal Business Name): JACLYN NICOLE HUNT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 10TH AVE
BROOKLYN NY
11219-2916
US

IV. Provider business mailing address

166 VANDERBILT AVE APT 2H
STATEN ISLAND NY
10304-2529
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-6000
  • Fax:
Mailing address:
  • Phone: 917-496-9759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF356482-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: