Provider Demographics
NPI:1821305046
Name:JEAN, MELISSA TESSA (ANP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:TESSA
Last Name:JEAN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:TESSA
Other - Last Name:NOEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:795 VIVIAN CT
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4546
Mailing Address - Country:US
Mailing Address - Phone:516-708-5711
Mailing Address - Fax:
Practice Address - Street 1:8551 ELIOT AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2760
Practice Address - Country:US
Practice Address - Phone:718-909-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY554830163W00000X
NY305911363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse