Jaclyn Roseann Cuccinello, NP
Nurse Practitioner, Women's Health in Port Jefferson Station, NY. Individual provider (NPI-1).
NPI number1043476237
StatusActive
Last updated in NPPESJul 11, 2019
Details
- NPI
- 1043476237
- Entity type
- Individual (NPI-1)
- Name
- Jaclyn Roseann Cuccinello
- Credential
- NP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 6, 2008
- Last updated
- Jul 11, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LW0102X | Nurse Practitioner, Women's Health | F421258-1 | NY | Yes |
| 163W00000X | Registered Nurse | 565107 | NY |
Practice location
5225 Rte 347 Ste 70Port Jefferson Station, NY 11776-2061
Phone 631-331-8777 · Fax 631-474-9169
Mailing address
5225 Rte 347 Ste 70Port Jefferson Station, NY 11776-2061
Phone 631-331-8777 · Fax 631-474-9169
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