Provider Demographics
NPI:1376778803
Name:PEZZULO, JOSEPH (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:PEZZULO
Suffix:
Gender:M
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 BOYLSTON ST
Mailing Address - Street 2:17E
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02199-7820
Mailing Address - Country:US
Mailing Address - Phone:305-801-1045
Mailing Address - Fax:
Practice Address - Street 1:881 COMMONWEALTH AVENUE, WEST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-353-3573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2010-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2258970363LA2100X
FLARNP9220338363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care