NPIMap

Organization Active NPI

Dynamic Family Health NP PLLC

  • Family Nurse Practitioner
  • East Patchogue, NY
National Provider Identifier
1487470423
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
DYNAMIC FAMILY HEALTH NP PLLC
Practice address
611 Medford Ave
East Patchogue, NY 11772-1307
Phone
(929) 519-4039
NPI assigned
Nov 25, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Nickolas Nathaniel Jackson, FNP-CNPI 1225628993
Title
Owner
Phone
(347) 759-9040

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

611 Medford Ave
East Patchogue, NY 11772-1307

Mailing address

13471 Bedell St
Jamaica, NY 11434-4551
Phone (347) 759-9040

National Provider Directory

National Provider Directory

Locations

611 Medford Ave
Patchogue, NY 11772
Phone (929) 519-4039

3305 Jerusalem Ave
Ste 110
Wantagh, NY 11793
Phone (516) 320-3999

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1487470423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13471 BEDELL ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114344551",
            "telephone_number": "347-759-9040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 MEDFORD AVE",
            "city": "EAST PATCHOGUE",
            "state": "NY",
            "postal_code": "117721307",
            "telephone_number": "929-519-4039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC FAMILY HEALTH NP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-25",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-24",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "NICKOLAS",
        "authorized_official_middle_name": "NATHANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "347-759-9040",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Patchogue, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.