Healthcare Provider Details

I. General information

NPI: 1205201530
Provider Name (Legal Business Name): JENNIFER CAMPOLI APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 OGLETOWN STANTON RD SUITE 3400
NEWARK DE
19713-2055
US

IV. Provider business mailing address

230 JASMINE LN
NEWARK DE
19702-3952
US

V. Phone/Fax

Practice location:
  • Phone: 302-366-1200
  • Fax: 302-366-1700
Mailing address:
  • Phone: 302-824-9452
  • Fax: 302-366-1700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0033691
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000889
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: