Provider Demographics
NPI:1083910210
Name:PALAZZO, JO MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:JO MARIE
Middle Name:
Last Name:PALAZZO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JO MARIE
Other - Middle Name:
Other - Last Name:BULLICER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2300 ROUTE 302
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10919-3242
Mailing Address - Country:US
Mailing Address - Phone:845-361-5597
Mailing Address - Fax:
Practice Address - Street 1:967 N BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1301
Practice Address - Country:US
Practice Address - Phone:914-964-4912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-05
Last Update Date:2011-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY541472163W00000X
NY336490363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse