Healthcare Provider Details

I. General information

NPI: 1285039032
Provider Name (Legal Business Name): JULIE ETIENNE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE ETIENNE FNP

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14732 JAMAICA AVE
JAMAICA NY
11435-4042
US

IV. Provider business mailing address

3503 DANIEL CRES
BALDWIN NY
11510-5153
US

V. Phone/Fax

Practice location:
  • Phone: 718-786-5000
  • Fax:
Mailing address:
  • Phone: 516-603-0509
  • Fax: 516-505-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number345034
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number6112721
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number61127201
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: