Healthcare Provider Details

I. General information

NPI: 1598626848
Provider Name (Legal Business Name): JESSICA MARIE FOX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 KEEWAYDIN CIR
PORT JEFFERSON NY
11777-2063
US

IV. Provider business mailing address

9 KEEWAYDIN CIR
PORT JEFFERSON NY
11777-2063
US

V. Phone/Fax

Practice location:
  • Phone: 631-834-2909
  • Fax:
Mailing address:
  • Phone: 631-834-2909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number359546
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number789527
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: