Provider Demographics
NPI:1891310629
Name:DELVA-JEMMOTT, NATHALIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MISS
First Name:NATHALIE
Middle Name:
Last Name:DELVA-JEMMOTT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7404 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2704
Mailing Address - Country:US
Mailing Address - Phone:718-439-5111
Mailing Address - Fax:
Practice Address - Street 1:12 BROOKLYN AVE APT 213
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1253
Practice Address - Country:US
Practice Address - Phone:516-859-7196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY718449-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health