Provider Demographics
NPI:1093432437
Name:MILLER, JESSICA GAILYN (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:GAILYN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 THOMPSON ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2530
Mailing Address - Country:US
Mailing Address - Phone:954-661-1050
Mailing Address - Fax:
Practice Address - Street 1:62 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-4052
Practice Address - Country:US
Practice Address - Phone:164-665-0533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily