Healthcare Provider Details

I. General information

NPI: 1891049276
Provider Name (Legal Business Name): GINA MARIE PALAZZOLO ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E. CARPENTER ST.
SPRINGFIELD IL
62701-6270
US

IV. Provider business mailing address

800 E. CARPENTER ST. C B 8054
SPRINGFIELD IL
62701-1010
US

V. Phone/Fax

Practice location:
  • Phone: 217-544-6464
  • Fax: 314-362-1185
Mailing address:
  • Phone: 217-544-6464
  • Fax: 314-747-5157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209010493
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2012039953
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: