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General NPI Number Information
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NPI Number | 1225866056
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Entity Type | Organization
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Legal Business Name | JACQUELYN MUROLO INC
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Dates
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Enumeration Date | 07/23/2024
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 7901 4TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4305
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Country | US
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Telephone | 631-240-3860
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Fax |
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Provider Business Mailing Address
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Address Line | 7901 4TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4305
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACQUELYN MUROLO
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Credential |
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Telephone | 631-240-3860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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