Provider Demographics
NPI:1659717387
Name:MASONE, JEANNA (ANP)
Entity Type:Individual
Prefix:MS
First Name:JEANNA
Middle Name:
Last Name:MASONE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PORT WASHINGTON BOULEVARD
Mailing Address - Street 2:ST. FRANCIS HOSPITAL
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1348
Mailing Address - Country:US
Mailing Address - Phone:516-562-6000
Mailing Address - Fax:516-562-6797
Practice Address - Street 1:129 EVERGREEN LN
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-5805
Practice Address - Country:US
Practice Address - Phone:631-903-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306210-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health