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General NPI Number Information
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NPI Number | 1760033294
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Entity Type | Individual
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Provider Name | JACQUELINE CONNERY NP-C
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Gender | Female
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 560 1ST AVE # 11EAST
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City | NEW YORK
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State | NY
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Zip | 10016-6402
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Country | US
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Telephone | 212-263-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 55 HOPE ST APT 214
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City | BROOKLYN
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State | NY
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Zip | 11211-4865
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Country | US
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Telephone | 914-629-1431
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | F309271-01
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License Number State | NY
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