Healthcare Provider Details

I. General information

NPI: 1093867707
Provider Name (Legal Business Name): JENNIFER PRYCE DNP, ANP-BC, GNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER DOUGLAS APRN-BC, ANP, GNP

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22219 LINDEN BLVD
JAMAICA NY
11411-1605
US

IV. Provider business mailing address

PO BOX 746087
ATLANTA GA
30374-6087
US

V. Phone/Fax

Practice location:
  • Phone: 718-765-6055
  • Fax: 347-808-4948
Mailing address:
  • Phone: 312-733-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF340587-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF303891-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: