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NPI Code Detail

MEDICARE: MS. JENNIFER ELLEN FACCIOLI ARNP

MEDICARE:  MS. JENNIFER ELLEN FACCIOLI  ARNP
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
1364SW0102XWomen's Health Clinical Nurse Specialist1756682FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2P63440OTHERUPIN

General Provider Information

NPI Number : 1891019063
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER ELLEN FACCIOLI ARNP
Provider Business Mailing Address
First Line : 725 107TH AVE N
Second Line :
City : NAPLES
State : FL
Zip : 34108-1858
Country : US
Telephone Number : 239-248-8695
Fax Number :
Provider Business Practice Location Address
First Line : 1425 CREECH RD
Second Line :
City : NAPLES
State : FL
Zip : 34103-4207
Country : US
Telephone Number : 239-262-8923
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2010
Last Update Date : 03/17/2010

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