Provider Demographics
NPI:1265180202
Name:DEGIACOMO, JESSICA (DNP/FNP)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:DEGIACOMO
Suffix:
Gender:F
Credentials:DNP/FNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MOULD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BENNETT CANCER CENTER
Mailing Address - Street 2:1 HOSPITAL PLAZA
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06904
Mailing Address - Country:US
Mailing Address - Phone:203-276-2695
Mailing Address - Fax:203-975-7842
Practice Address - Street 1:BENNETT CANCER CENTER
Practice Address - Street 2:1 HOSPITAL PLAZA
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06904
Practice Address - Country:US
Practice Address - Phone:203-276-2695
Practice Address - Fax:203-975-7842
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY668729163WX0200X
CT12467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0200XNursing Service ProvidersRegistered NurseOncology