Provider Demographics
NPI:1205014842
Name:JENSEN, MARIA ANTONIETA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ANTONIETA
Last Name:JENSEN
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 1:3280 OCEAN HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-3546
Mailing Address - Country:US
Mailing Address - Phone:516-650-8550
Mailing Address - Fax:
Practice Address - Street 1:3280 OCEAN HARBOR DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-3546
Practice Address - Country:US
Practice Address - Phone:516-650-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY509598 DUP163W00000X
NY40401438363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health