Individual provider Active NPI

Jessie M. Fisk, FNP-C

  • Family Nurse Practitioner
  • Ithaca, NY
National Provider Identifier
1629029384
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F331505 Issued in NY
Practice address
2359 N Triphammer Rd
Ithaca, NY 14850-1059
Phone
(607) 257-1691
Fax
(607) 257-3163
NPI assigned
May 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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 F331505 NY Primary

Addresses

Primary practice location

2359 N Triphammer Rd
Ithaca, NY 14850-1059

Mailing address

3749 Preston Rd
Cincinnatus, NY 13040-3100
Phone (607) 863-4796

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
331505NYMDLicensed Practical Nurse
F331505NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
I.a. Tangoren, M.D., P.L.L.C. PastSince Apr 5, 2004 Accepting new patients

Organizations & group practices 1

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": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1629029384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3749 PRESTON RD",
            "city": "CINCINNATUS",
            "state": "NY",
            "postal_code": "130403100",
            "telephone_number": "607-863-4796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2359 N TRIPHAMMER RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501059",
            "telephone_number": "607-257-1691",
            "fax_number": "607-257-3163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISK",
        "first_name": "JESSIE",
        "middle_name": "M.",
        "name_prefix": "Ms.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-15",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F331505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ithaca, NY

Sources for this page

Verify at the official NPI Registry.