Provider Demographics
NPI:1194527655
Name:JETER, TUNESIA SHAVON (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:TUNESIA
Middle Name:SHAVON
Last Name:JETER
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14850 BROOKVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-3275
Mailing Address - Country:US
Mailing Address - Phone:646-246-3432
Mailing Address - Fax:
Practice Address - Street 1:14850 BROOKVILLE BLVD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-3275
Practice Address - Country:US
Practice Address - Phone:646-246-3432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF356058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily