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Individual

LISA ELLEN JACAVONE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN/NP

Contact information

Practice address
830 CHALKSTONE AVE, PROVIDENCE, RI 02908-4734
(401) 273-7100
(401) 459-4797
Mailing address
830 CHALKSTONE AVE, PROVIDENCE, RI 02908-4734
(401) 273-7100
(401) 459-4797

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN36765
RI
363LA2100X
Acute Care Nurse Practitioner
NPP37867
RI
363LA2100X
Acute Care Nurse Practitioner
Primary
RN2274406
MA
363LP2300X
Primary Care Nurse Practitioner
APRN01777
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
APRN01777
ADVANCED PRACTICE REGISTERED NURSE LICENSE
RI
01
CNP2274406
CERTIFIED NURSE PRACTITIONER
MA
Enumeration date
10/04/2007
Last updated
01/24/2023
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