Provider Demographics
NPI:1952846446
Name:POLISTENA, JAMARY (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JAMARY
Middle Name:
Last Name:POLISTENA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 NE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-6202
Mailing Address - Country:US
Mailing Address - Phone:754-222-6642
Mailing Address - Fax:
Practice Address - Street 1:13550 S JOG RD
Practice Address - Street 2:SUITE 204
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3808
Practice Address - Country:US
Practice Address - Phone:561-515-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9292058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily