Provider Demographics
NPI:1477399871
Name:HOMETOWN HEALTHCARE PORT JERVIS FAMILY HEALTH NURSE PRACTITIONER PLLC
Entity type:Organization
Organization Name:HOMETOWN HEALTHCARE PORT JERVIS FAMILY HEALTH NURSE PRACTITIONER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSELLE
Authorized Official - Middle Name:AGUILA
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:845-204-8204
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-0048
Mailing Address - Country:US
Mailing Address - Phone:845-204-8204
Mailing Address - Fax:918-398-8354
Practice Address - Street 1:32 BALL ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-2404
Practice Address - Country:US
Practice Address - Phone:845-204-8204
Practice Address - Fax:918-398-9354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-04
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty