Healthcare Provider Details

I. General information

NPI: 1144200726
Provider Name (Legal Business Name): REBECCA HORNUNG JIANNUZZI PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 MIDLAND PARKWAY
SUMMERVILLE SC
29485-8102
US

IV. Provider business mailing address

312 MIDLAND PARKWAY
SUMMERVILLE SC
29485-8102
US

V. Phone/Fax

Practice location:
  • Phone: 843-875-6262
  • Fax: 843-873-7958
Mailing address:
  • Phone: 843-875-6262
  • Fax: 843-873-7958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2803
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20051312
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: