Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | ME124844 | FL |
NPI | 1255560363 |
---|---|
Provider Name | Dr. Jennifer Amy Criscola |
First Address | Saint Petersburg, FL 33701-4804 |
Second Address | Saint Petersburg, FL 33701-4804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2009 |
Last Update Date | 01/05/2018 |