Provider Demographics
NPI:1215582341
Name:PEREZ-HARGROVE, JENNINE (LPN)
Entity Type:Individual
Prefix:
First Name:JENNINE
Middle Name:
Last Name:PEREZ-HARGROVE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CARROL ST
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1854
Mailing Address - Country:US
Mailing Address - Phone:631-842-2885
Mailing Address - Fax:
Practice Address - Street 1:4238 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6016
Practice Address - Country:US
Practice Address - Phone:866-794-1644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331367164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse