Individual
MR. JAKE WALLACE CARZOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
11700 MS-57, VANCLEAVE, MS 39565
(228) 826-1482
Mailing address
509 PALM BREEZE DR, OCEAN SPRINGS, MS 39564-5532
(334) 728-0421
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
902499
MS
Other
Enumeration date
02/22/2018
Last updated
02/22/2018
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