Provider Demographics
NPI:1467252395
Name:JEAN, JOUDLIE (FNP)
Entity type:Individual
Prefix:
First Name:JOUDLIE
Middle Name:
Last Name:JEAN
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:JOUDLIE
Other - Middle Name:
Other - Last Name:JEAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:831-835 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07108-1393
Mailing Address - Country:US
Mailing Address - Phone:908-392-6058
Mailing Address - Fax:
Practice Address - Street 1:831-835 S 15TH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-1393
Practice Address - Country:US
Practice Address - Phone:908-392-6058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15297500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily