Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | APRN9186407 | FL |
NPI | 1033351176 |
---|---|
Provider Name | Jessica Mazzariello |
First Address | Tallahassee, FL 32312-2352 |
Second Address | Tallahassee, FL 32308-5054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2009 |
Last Update Date | 10/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001271900 | (05) | FL |
535535552E | (05) | GA |