Provider Demographics
NPI:1114205754
Name:ABOAGYE, JESSICA FRANCES (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:FRANCES
Last Name:ABOAGYE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:FRANCES
Other - Last Name:ENTENMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:57 WATERVILLE DR
Mailing Address - Street 2:
Mailing Address - City:SOUND BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11789-2138
Mailing Address - Country:US
Mailing Address - Phone:631-433-5098
Mailing Address - Fax:
Practice Address - Street 1:57 WATERVILLE DR
Practice Address - Street 2:
Practice Address - City:SOUND BEACH
Practice Address - State:NY
Practice Address - Zip Code:11789-2138
Practice Address - Country:US
Practice Address - Phone:631-433-5098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY658179163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health