Provider Demographics
NPI:1245793900
Name:POLATCHEK, JENNIFER PEACE (AGPCNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PEACE
Last Name:POLATCHEK
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 OCEAN PKWY APT 1D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1538
Mailing Address - Country:US
Mailing Address - Phone:718-812-7687
Mailing Address - Fax:
Practice Address - Street 1:40 OCEAN PKWY APT 1D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1538
Practice Address - Country:US
Practice Address - Phone:718-812-7687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309135363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care