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General NPI Number Information
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NPI Number | 1053089516
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Entity Type | Organization
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Legal Business Name | TRI COUNTY FAMILY HEALTH AND ADULT HEALTH NP SERVICES
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 204 COUNTY ROAD 39
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City | AFTON
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State | NY
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Zip | 13730-2252
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Country | US
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Telephone | 607-208-4284
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Fax | 607-900-3336
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Provider Business Mailing Address
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Address Line | 204 COUNTY ROAD 39
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City | AFTON
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State | NY
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Zip | 13730-2252
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Country | US
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Telephone | 607-208-4284
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Fax | 607-900-3336
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Authorized Official
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Title or Position | NP
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Name | MR. JOSEPH JOHN BRENNAN
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Credential | MBA, MS
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Telephone | 607-208-4284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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