Provider Demographics
NPI:1447891486
Name:LEE, JANE PARK (FNP-C)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:PARK
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 KINGSTON AVE
Mailing Address - Street 2:1ST FLOOR, ROOM H107
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1704
Mailing Address - Country:US
Mailing Address - Phone:347-425-1317
Mailing Address - Fax:718-221-1560
Practice Address - Street 1:600 KINGSTON AVE RM H107
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1704
Practice Address - Country:US
Practice Address - Phone:347-425-1317
Practice Address - Fax:718-221-1560
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty