Provider Demographics
NPI:1225154479
Name:INTERLICCHIA, TESS ANNA (FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:TESS
Middle Name:ANNA
Last Name:INTERLICCHIA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 E MARKET ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2650
Mailing Address - Country:US
Mailing Address - Phone:607-377-6832
Mailing Address - Fax:607-654-4122
Practice Address - Street 1:21 E MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2650
Practice Address - Country:US
Practice Address - Phone:607-377-6832
Practice Address - Fax:607-654-4122
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5463821163W00000X
PARN725497163W00000X
ME51639163WH0200X
PAP021329363LF0000X
NY342284363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health