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1043192602 NPI number — JESSICA THERESA BECERRA NP

NPI Number: 1043192602
Health Care Provider/Practitioner: JESSICA THERESA BECERRA NP

Information about “1043192602” NPI (JESSICA THERESA BECERRA NP) exists in 1043192602 in HTML format HTML  |  1043192602 in plain Text format TXT  |  1043192602 in PDF (Portable Document Format) PDF  |  1043192602 in an XML format XML  formats.

NPI Number : 1043192602 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043192602",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BECERRA",
    "FirstName": "JESSICA",
    "MiddleName": "THERESA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BECERRA",
    "OtherFirstName": "JESSICA",
    "OtherMiddleName": "THERESA",
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "NP",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "24 ARROWOOD LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MELVILLE",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11747-1545",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "917-217-0686",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "850 HICKSVILLE RD STE 104",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SEAFORD",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11783-1300",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "516-798-0141",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/24/2025",
    "LastUpdateDate": "10/03/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "357410",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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