Provider Demographics
NPI:1154671451
Name:NOZZOLILLO, AMY B (ARNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:NOZZOLILLO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:C
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 44008
Mailing Address - Street 2:UFJAX - PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:655 W. 8TH STREET
Practice Address - Street 2:UFJAX - DEPT. OF PEDIATRICS/NEONATOLOGY
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209
Practice Address - Country:US
Practice Address - Phone:904-244-5100
Practice Address - Fax:904-244-4301
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9259115363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0079645-00Medicaid
GA003130445AMedicaid
FL0079645-00Medicaid