| NPI | 1932601374 |
|---|---|
| Former Name | JENNIFER ARDELL DE FAZIO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 382103) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN178949) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN178949) | |
| Enumeration Date | 2018-03-01 |
| Last Update Date | 2025-10-24 |