Provider Demographics
NPI:1225846827
Name:JEAN BAPTISTE, ELISSANDER (PMHNP-C)
Entity type:Individual
Prefix:
First Name:ELISSANDER
Middle Name:
Last Name:JEAN BAPTISTE
Suffix:
Gender:M
Credentials:PMHNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 W END AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6228
Mailing Address - Country:US
Mailing Address - Phone:862-224-7799
Mailing Address - Fax:
Practice Address - Street 1:3350 W END AVE APT 3
Practice Address - Street 2:
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6228
Practice Address - Country:US
Practice Address - Phone:862-224-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP031535363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health