Jemilat Joy Azeez
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Farmington, CT
NPI 1700404167 · NPPES record last updated Aug 31, 2020
Key facts
- NPI
- 1700404167
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 8929 (CT)
- Practice address
- 270 Farmington Ave
Farmington, CT 06032-1909 - Phone
- (860) 677-5570
- NPI assigned
- Jul 10, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CT, GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201029001117 | CT | Practitioner - Nurse Practitioner | 8921418153 | Reassigns benefits to 1 organization |
| I20241229000054 | GA | Practitioner - Nurse Practitioner | 8921418153 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8929 | CT | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Connecticut Mental Health Specialists Inc | Psychiatric/Mental Health | Current |
Accepting new patients |
| Georgia Mso LLC | Current |
Accepting new patients | |
| Signify Health Medical Associates, PLLC | Current |
Accepting new patients | |
| Hardy Renew Wellness,LLC | Current |
Accepting new patients |
Locations
270 Farmington Ave
Ste 309
Farmington, CT 06032
Phone (860) 677-5570
289 S Culver St
Lawrenceville, GA 30046
Phone (404) 891-9833
1640 Powers Ferry Rd SE
Bldg 15
Marietta, GA 30067
Phone (770) 722-9595
4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 8929 | CT | Yes |
| Family Nurse Practitioner | 363LF0000X | 8929 | CT |
Addresses
Primary practice location
270 Farmington Ave
Farmington, CT 06032-1909
Mailing address
936 Red Wolf CT
Dacula, GA 30019-7429
Phone (404) 771-9236
Other providers in Farmington, CT
- Avon Allies LLC
- Amira Hassan Awadalla
- Razan Awadallah
- Niloufar Azami
- Mariam Shakir Azeem
- Misbah Aziz
- Michael A Azrin
- Roberta Nana Enyima Baah-Sackey
- Farah Baba
- Sarah Beth Babcock
All providers in Farmington, CT · Psychiatric/Mental Health Nurse Practitioner in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 31, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.