Healthcare Provider Details

I. General information

NPI: 1609698802
Provider Name (Legal Business Name): JUST CARE NURSE PRACTITIONER IN FAMILY HEALTH PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 CROMER RD E
ELMONT NY
11003-4825
US

IV. Provider business mailing address

612 CORPORATE WAY STE 2M
VALLEY COTTAGE NY
10989-2027
US

V. Phone/Fax

Practice location:
  • Phone: 877-258-6331
  • Fax:
Mailing address:
  • Phone: 877-258-6331
  • Fax: 718-362-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KAREN STAPLE
Title or Position: OWNER
Credential: NP
Phone: 877-258-6331