Healthcare Provider Details

I. General information

NPI: 1801484951
Provider Name (Legal Business Name): JENNA DENNINE PEART NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4771 HYLAN BLVD
STATEN ISLAND NY
10312-6315
US

IV. Provider business mailing address

PO BOX 5730
BELFAST ME
04915-5700
US

V. Phone/Fax

Practice location:
  • Phone: 718-948-8200
  • Fax: 718-317-4111
Mailing address:
  • Phone: 888-402-7256
  • Fax: 888-902-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number345554
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number345554
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1189246
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: