Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

MS. Idalissie Altagracia Peguero, APN, PMHNPBC

Individual provider Nurse Practitioner · NPI 1689154437

MS. Idalissie Altagracia Peguero, APN, PMHNPBC is a Nurse Practitioner in Newark, New Jersey. Qualified in 2023, 3 years ago. Practices with Jls Medical PC, a 54-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in New Jersey.

Years since qualifying
3
Licensed in
NJ
In the registry since
2018
Specialties on file
2
What do these letters mean?
APN — Advanced Practice Nurse
The umbrella title some states use for nurse practitioners and other advanced practice nurses.

See every abbreviation used in this directory →

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Practice location Address checks out

550 Broad St Ste 606
Newark, NJ 07102-4537
Phone: (201) 822-1161
Fax: (877) 485-8918
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 606 Broadway, Paterson, NJ 07514-1916 — (973) 523-4000

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 26NJ00838200 (NJ)
Nurse Practitioner Taxonomy 363L00000X · Licence 26NJ00838200 (NJ)

Record details

NPI number1689154437
Entity typeIndividual (Type 1)
GenderFemale
Credentials APN , PMHNPBC
Sole proprietorNo
NPI enumeratedAugust 20, 2018
Last updated in NPPESOctober 10, 2024
Certification dateOctober 10, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Jls Medical Pc — 54 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

Other providers in Newark