Provider Demographics
NPI:1891049276
Name:PALAZZOLO, GINA MARIE (ACNP)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIE
Last Name:PALAZZOLO
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E. CARPENTER ST.
Mailing Address - Street 2:C B 8054
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62701-1010
Mailing Address - Country:US
Mailing Address - Phone:217-544-6464
Mailing Address - Fax:314-747-5157
Practice Address - Street 1:800 E. CARPENTER ST.
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701-6270
Practice Address - Country:US
Practice Address - Phone:217-544-6464
Practice Address - Fax:314-362-1185
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010493363L00000X
MO2012039953363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care