Healthcare Provider Details

I. General information

NPI: 1336057892
Provider Name (Legal Business Name): JEANNIE CLAUDELLE FLORESTAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22305 131ST AVE
LAURELTON NY
11413-1702
US

IV. Provider business mailing address

22305 131ST AVE
LAURELTON NY
11413-1702
US

V. Phone/Fax

Practice location:
  • Phone: 347-557-9177
  • Fax:
Mailing address:
  • Phone: 347-557-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number656156
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: