Individual provider Active NPI

Jessica Ann Fantasia, RN

  • Registered Nurse
  • Harriman, NY
National Provider Identifier
1548695141
Registry record updated Sep 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
537368 Issued in NY
Practice address
15 Lexington Hills
#3
Harriman, NY 10926-3442
Phone
(845) 406-1765
NPI assigned
Sep 13, 2013
Last updated
Sep 13, 2013By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 13, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 537368 NY Primary

Addresses

Primary practice location

15 Lexington Hills
#3
Harriman, NY 10926-3442

Mailing address

15 Lexington Hills
Unit #3
Harriman, NY 10926-3442
Phone (845) 406-1765

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
537368NYMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1379030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379030400000",
    "number": "1548695141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 LEXINGTON HILLS",
            "address_2": "UNIT #3",
            "city": "HARRIMAN",
            "state": "NY",
            "postal_code": "109263442",
            "telephone_number": "845-406-1765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 LEXINGTON HILLS",
            "address_2": "#3",
            "city": "HARRIMAN",
            "state": "NY",
            "postal_code": "109263442",
            "telephone_number": "845-406-1765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANTASIA",
        "first_name": "JESSICA",
        "middle_name": "ANN",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-13",
        "last_updated": "2013-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "537368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harriman, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2013; 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.