Provider Demographics
NPI:1619590486
Name:JEREMIAH, JAN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:JEREMIAH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3839 FLATLANDS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3535
Mailing Address - Country:US
Mailing Address - Phone:718-338-5024
Mailing Address - Fax:718-338-5029
Practice Address - Street 1:3839 FLATLANDS AVE STE 100
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3535
Practice Address - Country:US
Practice Address - Phone:718-338-5024
Practice Address - Fax:718-338-5029
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF344290-1363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care