Healthcare Provider Details

I. General information

NPI: 1184792152
Provider Name (Legal Business Name): PRISCILLA JEAN-BAPTISTE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EVERCARE 1 PENN PLAZA, 7TH FL, STE.725
NEW YORK NY
10119
US

IV. Provider business mailing address

3765 RIVERDALE AVE STE 5
BRONX NY
10463-1845
US

V. Phone/Fax

Practice location:
  • Phone: 212-216-6490
  • Fax: 212-216-6606
Mailing address:
  • Phone: 718-601-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number334035-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: