Provider Demographics
NPI:1962264812
Name:NNAETO, JERMAINE A (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:JERMAINE
Middle Name:A
Last Name:NNAETO
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 ELMORA AVE STE 416
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1148
Mailing Address - Country:US
Mailing Address - Phone:908-488-6003
Mailing Address - Fax:908-585-4995
Practice Address - Street 1:162 ELMORA AVE STE 416
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1148
Practice Address - Country:US
Practice Address - Phone:908-488-6003
Practice Address - Fax:908-585-4995
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14995300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty