Provider Demographics
NPI:1700212578
Name:SAN ANTONIO, JANET JAZMIN (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:JAZMIN
Last Name:SAN ANTONIO
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67-19 AUSTIN STREET
Mailing Address - Street 2:APT. 1R
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:347-906-4776
Mailing Address - Fax:
Practice Address - Street 1:67-19 AUSTIN STREET
Practice Address - Street 2:APT. 1R
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:347-906-4776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY636786163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse