Provider Demographics
NPI:1134825771
Name:JOYCE, JACQUELINE EILEEN (PMHNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:EILEEN
Last Name:JOYCE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:EAST PEMBROKE
Mailing Address - State:NY
Mailing Address - Zip Code:14056-0256
Mailing Address - Country:US
Mailing Address - Phone:585-813-3608
Mailing Address - Fax:
Practice Address - Street 1:2553 MAIN ROAD
Practice Address - Street 2:
Practice Address - City:EAST PEMBROKE
Practice Address - State:NY
Practice Address - Zip Code:14056
Practice Address - Country:US
Practice Address - Phone:585-813-3608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY404576363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health