Provider Demographics
NPI:1255808697
Name:MUNOZ -ZAH, JALESSE A (ANP, NP-C)
Entity type:Individual
Prefix:
First Name:JALESSE
Middle Name:A
Last Name:MUNOZ -ZAH
Suffix:
Gender:F
Credentials:ANP, NP-C
Other - Prefix:
Other - First Name:JALESSE
Other - Middle Name:
Other - Last Name:MUNOZ ZAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JALESSE MUNOZ -ZAH
Mailing Address - Street 1:130 JEWETT AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-2004
Mailing Address - Country:US
Mailing Address - Phone:551-580-1123
Mailing Address - Fax:
Practice Address - Street 1:130 JEWETT AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-2004
Practice Address - Country:US
Practice Address - Phone:551-580-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00855800363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty