Healthcare Provider Details

I. General information

NPI: 1093593485
Provider Name (Legal Business Name): JACLYN A FARRINGTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACLYN A LATOURELLE

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 E MAIN ST STE 2A
CANTON NY
13617-1450
US

IV. Provider business mailing address

100 METROPOLITAN PARK DR STE 100
LIVERPOOL NY
13088-7112
US

V. Phone/Fax

Practice location:
  • Phone: 315-714-2559
  • Fax: 315-386-3056
Mailing address:
  • Phone: 315-870-9369
  • Fax: 315-870-9364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF352752
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: