Provider Demographics
NPI:1447841366
Name:JEAN-PAUL, ANNETTE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:JEAN-PAUL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:JEAN-PAUL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:115 BOSTON AVE UNIT 5112
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-9706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307
Practice Address - Country:US
Practice Address - Phone:415-651-3458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN253117363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty