Provider Demographics
NPI:1760937452
Name:VACCA, JEANNE MARIE DAMORE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JEANNE MARIE
Middle Name:DAMORE
Last Name:VACCA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2315
Mailing Address - Country:US
Mailing Address - Phone:845-473-8995
Mailing Address - Fax:
Practice Address - Street 1:461 WESTERN BLVD STE 122
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7637
Practice Address - Country:US
Practice Address - Phone:910-333-0283
Practice Address - Fax:910-333-0513
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015567363LF0000X
NYF340980363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily