Healthcare Provider Details

I. General information

NPI: 1164086575
Provider Name (Legal Business Name): JENNIFER CHRISTINE CICCARELLI AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 OLD FERN HILL RD STE 5
WEST CHESTER PA
19380-4269
US

IV. Provider business mailing address

207 N BROAD ST FL 3
PHILADELPHIA PA
19107-1500
US

V. Phone/Fax

Practice location:
  • Phone: 610-696-2850
  • Fax: 610-696-7159
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP020250
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: