Healthcare Provider Details

I. General information

NPI: 1750534509
Provider Name (Legal Business Name): JENNIFER L CICCHILLO N.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2008
Last Update Date: 08/10/2025
Certification Date: 08/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 AIKEN HUNT CIR
COLUMBIA SC
29223-8407
US

IV. Provider business mailing address

PO BOX 100523
FLORENCE SC
29502-0523
US

V. Phone/Fax

Practice location:
  • Phone: 843-669-5162
  • Fax: 843-667-4573
Mailing address:
  • Phone: 843-669-5162
  • Fax: 843-667-4573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number08356
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRX08356
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: