Provider Demographics
NPI:1407514888
Name:JEAN-GILLES, THAMAR DERISME (NP)
Entity type:Individual
Prefix:
First Name:THAMAR
Middle Name:DERISME
Last Name:JEAN-GILLES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PAERDEGAT 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4106
Mailing Address - Country:US
Mailing Address - Phone:347-404-3462
Mailing Address - Fax:
Practice Address - Street 1:466 BAY RIDGE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5906
Practice Address - Country:US
Practice Address - Phone:347-836-6923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily