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General NPI Number Information
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NPI Number | 1760038202
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Entity Type | Individual
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Provider Name | STACEY L JODICE DNP, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/12/2019
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 800 HUNTINGTON AVE FL 3
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City | BOSTON
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State | MA
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Zip | 02115-6303
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Country | US
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Telephone | 617-525-9548
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Fax |
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Provider Business Mailing Address
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Address Line | 28 HYCREST RD
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City | CHARLTON
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State | MA
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Zip | 01507-1568
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Country | US
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Telephone | 413-329-9017
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | RN2294699
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | RN2294699
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License Number State | MA
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