Individual provider Active NPI

Janaira J Tucker, FNP

  • Family Nurse Practitioner
  • Bay Shore, NY
National Provider Identifier
1245067594
Registry record updated Nov 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
354298 Issued in NY
Practice address
1916 Union Blvd
Bay Shore, NY 11706-7921
Phone
(516) 928-9202
NPI assigned
Sep 18, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 354298 NY Primary

Addresses

Primary practice location

1916 Union Blvd
Bay Shore, NY 11706-7921

Mailing address

1916 Union Blvd
Bay Shore, NY 11706-7921
Phone (516) 928-9202

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250310001367 NY Practitioner - Nurse Practitioner 2860913639 Reassigns benefits to 1 organization
Practice locations: North Babylon, NY

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1257 Deer Park Ave
Suite 136
North Babylon, NY 11703-3104
Phone (516) 928-9202

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
354298NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Premiere Cardiology PLLC CurrentSince Dec 16, 2024 Accepting new patients
Infuseme IV LLC Current Accepting new patients

Locations

1916 Union Blvd
Bay Shore, NY 11706
Phone (631) 666-2290

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1726617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732838400000",
    "number": "1245067594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1916 UNION BLVD",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117067921",
            "telephone_number": "516-928-9202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1916 UNION BLVD",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117067921",
            "telephone_number": "516-928-9202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "JANAIRA",
        "middle_name": "J",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-18",
        "last_updated": "2024-11-29",
        "certification_date": "2024-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "354298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay Shore, NY

Sources for this page

Verify at the official NPI Registry.