Healthcare Provider Details

I. General information

NPI: 1598331266
Provider Name (Legal Business Name): JENNIFER COLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S MEADOW ST
ITHACA NY
14850-5377
US

IV. Provider business mailing address

4 LEISURE LN
FREEVILLE NY
13068-9523
US

V. Phone/Fax

Practice location:
  • Phone: 607-319-4563
  • Fax:
Mailing address:
  • Phone: 607-592-5157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number543863
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348177
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF348177
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: