Provider Demographics
NPI:1285039032
Name:ETIENNE, JULIE (FNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ETIENNE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:ETIENNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:3503 DANIEL CRES
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-5153
Mailing Address - Country:US
Mailing Address - Phone:516-603-0509
Mailing Address - Fax:516-505-0610
Practice Address - Street 1:14732 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-4042
Practice Address - Country:US
Practice Address - Phone:718-786-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345034363LF0000X
NY6112721163W00000X
NY61127201363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner