Provider Demographics
NPI:1083341598
Name:JEAN-RAYMOND, JOLIETTE N (APRN)
Entity Type:Individual
Prefix:
First Name:JOLIETTE
Middle Name:N
Last Name:JEAN-RAYMOND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-3144
Mailing Address - Country:US
Mailing Address - Phone:631-299-1507
Mailing Address - Fax:
Practice Address - Street 1:250 8TH AVE
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-3144
Practice Address - Country:US
Practice Address - Phone:631-288-1507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF310442-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health