Individual
MRS. JACQUELINE ROSE IANNICCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSED, ATC, CSCS
Contact information
Practice address
601 CHILDRENS LN, SPORTS & ADOLESCENT MEDICINE, NORFOLK, VA 23507-1910
(757) 668-7850
Mailing address
1241 QUARTER WAY, VIRGINIA BEACH, VA 23464-8511
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126000528
VA
Other
Enumeration date
08/25/2006
Last updated
08/06/2014
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