Provider Demographics
NPI:1144200726
Name:JIANNUZZI, REBECCA HORNUNG (PNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:HORNUNG
Last Name:JIANNUZZI
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 MIDLAND PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8102
Mailing Address - Country:US
Mailing Address - Phone:843-875-6262
Mailing Address - Fax:843-873-7958
Practice Address - Street 1:312 MIDLAND PARKWAY
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8102
Practice Address - Country:US
Practice Address - Phone:843-875-6262
Practice Address - Fax:843-873-7958
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2803363LP0200X
SC20051312208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC028035Medicaid
SCAA58188798Medicare PIN