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NPI Code Detail

MEDICARE: MRS. JESSICA RAWSON SWIATOCHA FNP

MEDICARE: MRS. JESSICA RAWSON SWIATOCHA FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WC3500XCardiac Rehabilitation Registered Nurse523059NY
2363LF0000XFamily Nurse PractitionerF334575-1NY

General Provider Information

NPI Number : 1063419588
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA RAWSON SWIATOCHA FNP
Provider Business Mailing Address
First Line : 35 BEECHWOOD DR
Second Line :
City : SOUTHAMPTON
State : NY
Zip : 11968-2206
Country : US
Telephone Number : 631-726-8620
Fax Number : 631-726-8680
Provider Business Practice Location Address
First Line : 240 MEETING HOUSE LN
Second Line :
City : SOUTHAMPTON
State : NY
Zip : 11968-5009
Country : US
Telephone Number : 631-283-2070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2005
Last Update Date : 03/07/2023

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