Individual
MRS. JENNIFER MARIE ILACQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, ACNP-BC
Contact information
Practice address
1500 E MEDICAL CENTER DR, FLOOR 3 CARDIOVASCULAR CENTER, ANN ARBOR, MI 48109-5000
(888) 287-1082
(734) 232-4505
Mailing address
3621 S STATE ST, 700 KMS PLACE, ANN ARBOR, MI 48108-1633
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704242794
MI
363LA2100X
Acute Care Nurse Practitioner
Primary
4704242794
MI
Other
Enumeration date
08/02/2012
Last updated
05/09/2013
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