Provider Demographics
NPI:1780370361
Name:HUNTER, JACQUELINE TANYA (RN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:TANYA
Last Name:HUNTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 L ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3708
Mailing Address - Country:US
Mailing Address - Phone:917-655-9538
Mailing Address - Fax:
Practice Address - Street 1:1426 L ST
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3708
Practice Address - Country:US
Practice Address - Phone:917-655-9538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY664161171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach