Healthcare Provider Details

I. General information

NPI: 1891957551
Provider Name (Legal Business Name): JEANNETTE FLYNN APN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 MASON AVE # C
STATEN ISLAND NY
10305-3408
US

IV. Provider business mailing address

256 MASON AVE # C
STATEN ISLAND NY
10305-3408
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-6137
  • Fax: 718-226-6434
Mailing address:
  • Phone: 718-226-6137
  • Fax: 718-226-6434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ00005700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF382519
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: