Healthcare Provider Details

I. General information

NPI: 1124565171
Provider Name (Legal Business Name): JACLYN ALYSSA MASULLI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CEDAR HILL ST
MARLBOROUGH MA
01752-5900
US

IV. Provider business mailing address

225 CEDAR HILL ST
MARLBOROUGH MA
01752-5900
US

V. Phone/Fax

Practice location:
  • Phone: 615-673-4455
  • Fax:
Mailing address:
  • Phone: 615-673-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2306800
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN2306800
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: