Provider Demographics
NPI:1427533926
Name:HART, JOCELYN ANNE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:ANNE
Last Name:HART
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:NY
Mailing Address - Zip Code:12972-2821
Mailing Address - Country:US
Mailing Address - Phone:518-643-6166
Mailing Address - Fax:
Practice Address - Street 1:116 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:NY
Practice Address - Zip Code:12972-2821
Practice Address - Country:US
Practice Address - Phone:518-643-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY608397163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY772846770OtherDRIVERS LICENSE