Healthcare Provider Details

I. General information

NPI: 1164310025
Provider Name (Legal Business Name): JESSICA LOUISE TOACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 GENESEE ST
AUBURN NY
13021-3503
US

IV. Provider business mailing address

12 SHERMAN ST
NEW HARTFORD NY
13413-2646
US

V. Phone/Fax

Practice location:
  • Phone: 315-253-8477
  • Fax:
Mailing address:
  • Phone: 315-601-5515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number354934
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: