Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | ARNP9259115 | FL |
NPI | 1154671451 |
---|---|
Provider Name | Amy B Nozzolillo |
First Address | Jacksonville, FL 32231 |
Second Address | Jacksonville, FL 32209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2012 |
Last Update Date | 20/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003130445A | (05) | GA |
0079645-00 | (05) | FL |