Provider Demographics
NPI:1750344529
Name:HARVEY, JENNIFER CORETTA (CRNA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CORETTA
Last Name:HARVEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 GOLD ST #32A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3051
Mailing Address - Country:US
Mailing Address - Phone:732-899-0868
Mailing Address - Fax:732-899-5167
Practice Address - Street 1:577 PROSPECT AVE BASEMENT SUITE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6065
Practice Address - Country:US
Practice Address - Phone:718-369-1444
Practice Address - Fax:718-369-3066
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY454924-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ32489Medicare UPIN
NYR3C211Medicare ID - Type Unspecified