Jennifer Cannizzaro, CRNP | |
2021 Guadalupe St Ste 260, Austin, TX 78705-5654 | |
(346) 372-7216 | |
Not Available |
Full Name | Jennifer Cannizzaro |
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Gender | Female |
Speciality | Nurse Practitioner - Family |
Location | 2021 Guadalupe St Ste 260, Austin, Texas |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1659752889 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363LF0000X | Nurse Practitioner - Family | 1139956 (Texas) | Secondary |
363LF0000X | Nurse Practitioner - Family | SP015076 (Pennsylvania) | Primary |
Entity Name | Cleanslate Medical Group Of Pennsylvania Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1184177263 PECOS PAC ID: 8426334400 Enrollment ID: O20170405000660 |
Mailing Address | Practice Location Address |
---|---|
Jennifer Cannizzaro, CRNP 2021 Guadalupe St Ste 260, Austin, TX 78705-5654 Ph: (346) 372-7216 | Jennifer Cannizzaro, CRNP 2021 Guadalupe St Ste 260, Austin, TX 78705-5654 Ph: (346) 372-7216 |
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