Provider Demographics
NPI:1003056888
Name:JOSEPH, JACQUELINE DESIREE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:DESIREE
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2128
Mailing Address - Country:US
Mailing Address - Phone:570-420-8070
Mailing Address - Fax:
Practice Address - Street 1:116 N HIGH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1810
Practice Address - Country:US
Practice Address - Phone:914-699-2154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5727171163W00000X
PASP024568363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse