Healthcare Provider Details

I. General information

NPI: 1053089516
Provider Name (Legal Business Name): TRI COUNTY FAMILY HEALTH AND ADULT HEALTH NP SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 COUNTY ROAD 39
AFTON NY
13730-2252
US

IV. Provider business mailing address

204 COUNTY ROAD 39
AFTON NY
13730-2252
US

V. Phone/Fax

Practice location:
  • Phone: 607-208-4284
  • Fax: 607-900-3336
Mailing address:
  • Phone: 607-208-4284
  • Fax: 607-900-3336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH JOHN BRENNAN
Title or Position: NP
Credential: MBA, MS
Phone: 607-208-4284