Individual
JONATHAN PRINCIOTTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2500 N STATE ST, 2500 NORTH STATE STREET, JACKSON, MS 39216-4500
(601) 815-6960
Mailing address
510 PINEBARK CV, BRANDON, MS 39047-4447
(228) 238-9187
Taxonomy
Speciality
Code
Description
License number
State
363LP0222X
Critical Care Pediatric Nurse Practitioner
Primary
901958
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05103351
—
MS
Enumeration date
02/13/2017
Last updated
04/05/2017
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