Provider Demographics
NPI:1649727603
Name:BRESLIN, COURTNEY JILL (NP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JILL
Last Name:BRESLIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:JILL
Other - Last Name:HAGGERTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:372 POST AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2201
Mailing Address - Country:US
Mailing Address - Phone:516-333-1444
Mailing Address - Fax:516-333-2725
Practice Address - Street 1:372 POST AVE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-2201
Practice Address - Country:US
Practice Address - Phone:516-333-1444
Practice Address - Fax:516-333-2725
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30-307931363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health