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NPI Code Detail

MEDICARE: MS. TUNESIA SHAVON JETER FNP-BC

MEDICARE: MS. TUNESIA SHAVON JETER FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerF356058NY

General Provider Information

NPI Number : 1194527655
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TUNESIA SHAVON JETER FNP-BC
Provider Business Mailing Address
First Line : 14850 BROOKVILLE BLVD
Second Line :
City : ROSEDALE
State : NY
Zip : 11422-3275
Country : US
Telephone Number : 646-246-3432
Fax Number :
Provider Business Practice Location Address
First Line : 451 CLARKSON AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-2054
Country : US
Telephone Number : 718-245-4620
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2025
Last Update Date : 05/22/2026

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