Healthcare Provider Details

I. General information

NPI: 1164042578
Provider Name (Legal Business Name): JEANNIE-ANNE PARLAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2020
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13750 JAMAICA AVE
JAMAICA NY
11435-3610
US

IV. Provider business mailing address

20628 45TH RD
BAYSIDE NY
11361-3121
US

V. Phone/Fax

Practice location:
  • Phone: 718-298-5100
  • Fax:
Mailing address:
  • Phone: 718-785-6720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF309365-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: