Healthcare Provider Details

I. General information

NPI: 1952929200
Provider Name (Legal Business Name): JODIE DANIELLE CARNCROSS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 PRESIDENTIAL PLAZA 1ST FL
SYRACUSE NY
13202
US

IV. Provider business mailing address

251 SALINA MEADOWS PKWY SUITE 100
SYRACUSE NY
13212-4516
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5210
  • Fax: 315-464-2141
Mailing address:
  • Phone: 315-464-2000
  • Fax: 315-464-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF346088-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number346088
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: