Jucy Tiesenga, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209009046 Issued in IL

Practice address

25 N Winfield Rd Ste 420
Winfield, IL 60190-1222

Phone

(630) 682-8700

Fax

(630) 352-5582

NPI assigned

Nov 18, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Endeavor Health Medical Group

  • Emergency Medicine Physician
  • Evanston, IL
  • NPI 1497701882
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639353600000",
    "number": "1124395199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1880 W WINCHESTER RD STE 201",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485336",
            "telephone_number": "847-247-0187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 N WINFIELD RD STE 420",
            "city": "WINFIELD",
            "state": "IL",
            "postal_code": "601901222",
            "telephone_number": "630-682-8700",
            "fax_number": "630-352-5582"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9669 Kenton Ave",
            "address_2": "Suite 204",
            "address_purpose": "LOCATION",
            "city": "Skokie",
            "state": "IL",
            "postal_code": "600761266",
            "country_code": "US",
            "telephone_number": "847-657-1900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1880 W Winchester Rd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Libertyville",
            "state": "IL",
            "postal_code": "600485336",
            "country_code": "US",
            "telephone_number": "847-247-0187",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIESENGA",
        "first_name": "JUCY",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-11-18",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209009046",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209009046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jtiesenga313237@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1880 W Winchester Rd Ste 201",
            "city": "Libertyville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600485336",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Katherine B Taylor, APRN
• Nouzha Tazi Mzaalek, MD
• Johnny B Terry Jr., PHYSICIAN ASSISTANT
• Eric Tessmann, LSW
• Diane Marie Thomas, PSY.D., LCPC
• Jocelyn Tolentino, MD
• Alexander Allan Tomas, APRN, CRNA
• Cathy Gaza Tomasik, M.S., CCC-SLP
• Jonathan Michael Tomasko, M.D.
• Todd Tomson, MD

• Nurse Practitioner in Winfield, IL
• Providers in Winfield, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.