MEDICARE: JESSICA MARIE MOCK MSN, APRN, AGPCNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	F312230-01	NY

General Provider Information

NPI Number	:	1720872294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARIE MOCK MSN, APRN, AGPCNP-C

Provider Business Mailing Address
First Line	:	445 ABINGDON AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-1319
Country	:	US
Telephone Number	:	718-807-1892
Fax Number	:

Provider Business Practice Location Address
First Line	:	445 ABINGDON AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-1319
Country	:	US
Telephone Number	:	718-807-1892
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2025
Last Update Date	:	04/08/2025

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