Healthcare Provider Details

I. General information

NPI: 1679367940
Provider Name (Legal Business Name): JAZMYNE NICOLE BRIERRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21017 113TH AVE
QUEENS VILLAGE NY
11429-2305
US

IV. Provider business mailing address

300 POMPTON RD
WAYNE NJ
07470-2103
US

V. Phone/Fax

Practice location:
  • Phone: 718-465-1870
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number357428
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number847054
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR26237300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: