Provider Demographics
NPI:1851052195
Name:GOLDBLATT, JESSICA SARA (RN, MSN, FNP, APRN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SARA
Last Name:GOLDBLATT
Suffix:
Gender:F
Credentials:RN, MSN, FNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1606
Mailing Address - Country:US
Mailing Address - Phone:516-659-0519
Mailing Address - Fax:
Practice Address - Street 1:918 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1606
Practice Address - Country:US
Practice Address - Phone:516-659-0519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-09
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF344504-01363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care