Individual
JESSICA BASSO ANTONELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
218 BRIGHTON PARK BLVD STE 101, SUMMERVILLE, SC 29486-3013
(843) 471-1135
Mailing address
3062 GRINNELL ST, JOHNS ISLAND, SC 29455-4950
(410) 499-4157
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
23277
SC
363LF0000X
Family Nurse Practitioner
344143
NY
Other
Enumeration date
05/16/2019
Last updated
06/25/2025
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