Provider Demographics
NPI:1609652965
Name:AMATUCCIO, HEATHER JADE (FNP-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:JADE
Last Name:AMATUCCIO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1316
Mailing Address - Country:US
Mailing Address - Phone:607-334-6378
Mailing Address - Fax:607-336-1304
Practice Address - Street 1:5 CORTLAND ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1316
Practice Address - Country:US
Practice Address - Phone:607-334-6378
Practice Address - Fax:607-336-1304
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY351928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily