Healthcare Provider Details

I. General information

NPI: 1063660389
Provider Name (Legal Business Name): JENNIFER TEMPESTA RN, MSN, ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 GLEN LN
GLENWOOD LANDING NY
11547-3002
US

IV. Provider business mailing address

13 GLEN LN
GLENWOOD LANDING NY
11547-3002
US

V. Phone/Fax

Practice location:
  • Phone: 516-725-5853
  • Fax:
Mailing address:
  • Phone: 917-526-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number30304966
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: