Jennifer Dawn Condlin, RN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

346007 Issued in NY

Practice address

75 North Country Road
Portjefferson, NY 11777

Phone

(631) 473-1320

NPI assigned

Sep 10, 2011

Reactivated

Apr 20, 2021

Last updated

May 5, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1315612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620172800000",
    "number": "1720360340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 NORTH COUNTRY ROAD",
            "city": "PORTJEFFERSON",
            "state": "NY",
            "postal_code": "11777",
            "telephone_number": "631-473-1320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 NORTH COUNTRY ROAD",
            "city": "PORTJEFFERSON",
            "state": "NY",
            "postal_code": "11777",
            "telephone_number": "631-473-1320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONDLIN",
        "first_name": "JENNIFER",
        "middle_name": "DAWN",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-10",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "deactivation_date": "2020-11-24",
        "reactivation_date": "2021-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "636754-1",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F346007-01",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "346007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rheanna Louise Cluckey
• Asheley Rae Cockren, PA-C
• Margaret Mary Coffey, NP
• Joanna M Coleman
• Maria Christina Comillas, RN
• Heather Patrice Coniglio, MA, CCC-SLP
• Kelly Ann Connors, NP
• Kellianne Contri-McCann, PT, DPT, CLT
• Steven C Cortes
• Alfred Joseph Cossari Jr., MD

• Family Nurse Practitioner in Port Jefferson, NY
• Providers in Port Jefferson, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2021; 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.