Individual
COLLETTA LATOYA JERRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1548 E FORKS RD, BAY SHORE, NY 11706-3144
(631) 308-7658
Mailing address
1548 E FORKS RD, BAY SHORE, NY 11706-3144
(631) 308-7658
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F403813-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F403813-01
NEW YORK STATE OFFICE OF THE PROFESSIONS
NY
Enumeration date
09/16/2022
Last updated
09/16/2022
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