Provider Demographics
NPI:1275264376
Name:PRESTIGIACOMO, JO-ELENA (FNP)
Entity Type:Individual
Prefix:
First Name:JO-ELENA
Middle Name:
Last Name:PRESTIGIACOMO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 70TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1607
Mailing Address - Country:US
Mailing Address - Phone:917-715-9109
Mailing Address - Fax:
Practice Address - Street 1:1357 70TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1607
Practice Address - Country:US
Practice Address - Phone:917-715-9109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349599363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty