# COLLETTA LATOYA JERRICK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1922720887
- **Gender:** F
- **Credential:** NURSE PRACTITIONER

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | F403813-01 | NY | Yes |

## Other

- **Enumeration date:** 09/16/2022
- **Last updated:** 09/16/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | F403813-01 | NEW YORK STATE OFFICE OF THE PROFESSIONS | NY |