Healthcare Provider Details

I. General information

NPI: 1871992693
Provider Name (Legal Business Name): REBECCA JENNIFER RENSY-TALLARICO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA JENNIFER RENSY FNP

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5496 E TAFT RD
NORTH SYRACUSE NY
13212-3784
US

IV. Provider business mailing address

17 LANSING STREET
AUBURN NY
13021
US

V. Phone/Fax

Practice location:
  • Phone: 315-552-6700
  • Fax: 315-552-6701
Mailing address:
  • Phone: 315-255-7438
  • Fax: 315-255-7018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number338788
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: