MEDICARE: MRS. JENNIFER L CICCHILLO N.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	08356	OH
2	363LA2200X	Adult Health Nurse Practitioner	RX08356	OH

General Provider Information

NPI Number	:	1750534509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER L CICCHILLO N.P.C.

Provider Business Mailing Address
First Line	:	PO BOX 100523
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29502-0523
Country	:	US
Telephone Number	:	843-669-5162
Fax Number	:	843-667-4573

Provider Business Practice Location Address
First Line	:	327 AIKEN HUNT CIR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-8407
Country	:	US
Telephone Number	:	843-669-5162
Fax Number	:	843-667-4573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2008
Last Update Date	:	08/10/2025

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