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Individual
KELLY MARIE IANNAZZO
Active
Individual
KELLY MARIE IANNAZZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1886
SC
363A00000X
Physician Assistant
MA053583
PA
363A00000X
Physician Assistant
Primary
PA 9108977
FL
Other
Enumeration date
01/20/2009
Last updated
01/05/2016
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