Healthcare Provider Details

I. General information

NPI: 1508520917
Provider Name (Legal Business Name): JAMIE DOROTHY PORTEUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 PARK AVE S FL 6
NEW YORK NY
10016-8410
US

IV. Provider business mailing address

419 PARK AVE S FL 6
NEW YORK NY
10016-8410
US

V. Phone/Fax

Practice location:
  • Phone: 888-402-3972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11037424
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15304800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11179
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP032425
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348175
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1108472
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: