Provider Demographics
NPI:1891423364
Name:COOK-GARARD, JEANINE LEANORA X (NP)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:LEANORA
Last Name:COOK-GARARD
Suffix:X
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JEANINE
Other - Middle Name:
Other - Last Name:COOK-GARARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1 WINDSOR GATE DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6756
Mailing Address - Country:US
Mailing Address - Phone:516-768-3432
Mailing Address - Fax:
Practice Address - Street 1:1 WINDSOR GATE DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6756
Practice Address - Country:US
Practice Address - Phone:516-768-3432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340382-01363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology