Provider Demographics
NPI:1821500992
Name:THALAPPILLIL, JASMINE (AGPCNP)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:THALAPPILLIL
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 GILFORD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3939
Mailing Address - Country:US
Mailing Address - Phone:917-536-5556
Mailing Address - Fax:
Practice Address - Street 1:3400 BAINBRIDGE AVENUE
Practice Address - Street 2:LOWER LEVEL SUITE 400
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2404
Practice Address - Country:US
Practice Address - Phone:718-920-5264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308253363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health