Healthcare Provider Details

I. General information

NPI: 1780782573
Provider Name (Legal Business Name): JENNIFER FABRIZI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER CZIPRUSZ

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 SEACOAST PKWY
MT PLEASANT SC
29464-8247
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 843-881-4440
  • Fax: 843-884-8540
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1048
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0007574
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: