Provider Demographics
NPI:1225394422
Name:JARRETT, STACY-ANN GERDINE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:STACY-ANN
Middle Name:GERDINE
Last Name:JARRETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 BROADWAY APT 74
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2142
Mailing Address - Country:US
Mailing Address - Phone:134-764-5933
Mailing Address - Fax:
Practice Address - Street 1:615 BROADWAY APT 74
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2142
Practice Address - Country:US
Practice Address - Phone:134-764-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3369-1174400000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily