Healthcare Provider Details

I. General information

NPI: 1225098635
Provider Name (Legal Business Name): JESSICA L TISCI M.S., P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 STANDART AVE
AUBURN NY
13021-1508
US

IV. Provider business mailing address

4700 EXCHANGE CT STE 110
BOCA RATON FL
33431-4450
US

V. Phone/Fax

Practice location:
  • Phone: 315-255-1100
  • Fax: 315-255-1322
Mailing address:
  • Phone: 561-948-0291
  • Fax: 561-859-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010608-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: