Healthcare Provider Details

I. General information

NPI: 1134825771
Provider Name (Legal Business Name): JACQUELINE EILEEN JOYCE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2553 MAIN ROAD
EAST PEMBROKE NY
14056
US

IV. Provider business mailing address

PO BOX 256
EAST PEMBROKE NY
14056-0256
US

V. Phone/Fax

Practice location:
  • Phone: 585-813-3608
  • Fax:
Mailing address:
  • Phone: 585-813-3608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404576
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: