Provider Demographics
NPI:1336821289
Name:PETIT-FRERE, SHARISSA (APRN)
Entity type:Individual
Prefix:
First Name:SHARISSA
Middle Name:
Last Name:PETIT-FRERE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3409
Mailing Address - Country:US
Mailing Address - Phone:908-447-3824
Mailing Address - Fax:
Practice Address - Street 1:1171 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2200
Practice Address - Country:US
Practice Address - Phone:908-351-5384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352115363LF0000X
NJ26NJ14872900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily