Healthcare Provider Details

I. General information

NPI: 1669471314
Provider Name (Legal Business Name): CHRISTINE M. MAZZOLA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 OMEGA DR STE 86
NEWARK DE
19713-2065
US

IV. Provider business mailing address

405 SILVERSIDE RD STE 111
WILMINGTON DE
19809-1768
US

V. Phone/Fax

Practice location:
  • Phone: 302-738-5500
  • Fax: 302-738-9449
Mailing address:
  • Phone: 302-798-0666
  • Fax: 302-798-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000288
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: