Individual
JACQUELYN SUZETTE AMMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
9330 MEDICAL PLAZA DR, CHARLESTON, SC 29406-9104
(843) 847-4876
Mailing address
9330 MEDICAL PLAZA DR, NORTH CHARLESTON, SC 29406-9104
(843) 847-4882
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
21768
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720210586
ICC HEALTHCARE LLC
—
Enumeration date
06/12/2018
Last updated
09/23/2024
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