Provider Demographics
NPI:1043771504
Name:OZZELLO, JENNIFER M (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:OZZELLO
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 HEWITT DR STE 103-112
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6686
Mailing Address - Country:US
Mailing Address - Phone:806-412-4489
Mailing Address - Fax:855-466-1322
Practice Address - Street 1:208 HEWITT DR STE 103-112
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6686
Practice Address - Country:US
Practice Address - Phone:806-412-4489
Practice Address - Fax:855-466-1322
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154416363LP0808X
TX890724163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse