Provider Demographics
NPI:1437634383
Name:BOCCIA, JERI LYNNE (NP)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:LYNNE
Last Name:BOCCIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JERI
Other - Middle Name:LYNNE
Other - Last Name:TROUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 INDUSTRIAL TRACT ANX
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-1505
Mailing Address - Country:US
Mailing Address - Phone:518-291-8844
Mailing Address - Fax:
Practice Address - Street 1:35 INDUSTRIAL TRACT ANX
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1505
Practice Address - Country:US
Practice Address - Phone:518-291-8844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF342698-1363LF0000X
NY342698363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily