Healthcare Provider Details

I. General information

NPI: 1609357250
Provider Name (Legal Business Name): JENNIFER GIATAS CRNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 N MAIN ST
PROVIDENCE RI
02904-5719
US

IV. Provider business mailing address

1085 N MAIN ST
PROVIDENCE RI
02904-5719
US

V. Phone/Fax

Practice location:
  • Phone: 401-415-4618
  • Fax: 401-415-4348
Mailing address:
  • Phone: 401-615-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN01794
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN01794
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: