Provider Demographics
NPI:1225098635
Name:TISCI, JESSICA L (MS, PA)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:L
Last Name:TISCI
Suffix:
Gender:F
Credentials:MS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 STANDART AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1508
Mailing Address - Country:US
Mailing Address - Phone:315-729-8416
Mailing Address - Fax:
Practice Address - Street 1:144 STANDART AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1508
Practice Address - Country:US
Practice Address - Phone:315-255-1100
Practice Address - Fax:315-255-1322
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010608-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ45020Medicare UPIN