Provider Demographics
NPI:1467963710
Name:DIPPOLITO-TRIPP, ALISSA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:MARIE
Last Name:DIPPOLITO-TRIPP
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 1:1001 W FAYETTE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2866
Mailing Address - Country:US
Mailing Address - Phone:315-937-3276
Mailing Address - Fax:315-937-3676
Practice Address - Street 1:5700 W GENESEE ST STE 109N
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-3203
Practice Address - Country:US
Practice Address - Phone:315-487-1573
Practice Address - Fax:315-487-2418
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3410823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04940061Medicaid