Individual
JESSICA BACCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
458 S 12TH ST, LINDENHURST, NY 11757-4520
(516) 661-4954
Mailing address
458 S 12TH ST, LINDENHURST, NY 11757-4520
(516) 661-4954
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
668606-1
NY
363LP0200X
Pediatric Nurse Practitioner
Primary
202223706
NY
Other
Enumeration date
01/15/2014
Last updated
08/23/2022
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