Provider Demographics
NPI:1003507450
Name:RAVELO-RODRIGUEZ, JEANETTE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:RAVELO-RODRIGUEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 EMORY ST UNIT 211
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-7131
Mailing Address - Country:US
Mailing Address - Phone:732-423-8221
Mailing Address - Fax:
Practice Address - Street 1:46 NEWMAN SPRINGS RD E
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1530
Practice Address - Country:US
Practice Address - Phone:732-933-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care