Basic Information
| Provider Information | |||||||||
| NPI: | 1386090710 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | JAMILA | ||||||||
| MiddleName: | EFIA | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141K MANORHAVEN BLVD | ||||||||
| Address2: | |||||||||
| City: | PORT WASHINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110501555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6465964853 | ||||||||
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| Practice Location | |||||||||
| Address1: | 979 CROSS BRONX EXPY | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186657565 | ||||||||
| FaxNumber: | 3472264092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2016 | ||||||||
| LastUpdateDate: | 02/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F339939-1 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.