Healthcare Provider Details

I. General information

NPI: 1043192602
Provider Name (Legal Business Name): JESSICA THERESA BECERRA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA THERESA BECERRA NP

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HICKSVILLE RD STE 104
SEAFORD NY
11783-1300
US

IV. Provider business mailing address

24 ARROWOOD LN
MELVILLE NY
11747-1545
US

V. Phone/Fax

Practice location:
  • Phone: 516-798-0141
  • Fax:
Mailing address:
  • Phone: 917-217-0686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number357410
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: