Provider Demographics
NPI:1396290607
Name:CACIOPPO, JENNIFER F (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:F
Last Name:CACIOPPO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 OAKMONT DR
Mailing Address - Street 2:
Mailing Address - City:CARRIERE
Mailing Address - State:MS
Mailing Address - Zip Code:39426-7445
Mailing Address - Country:US
Mailing Address - Phone:601-569-1821
Mailing Address - Fax:
Practice Address - Street 1:2274 HIGHWAY 43 S
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-8141
Practice Address - Country:US
Practice Address - Phone:601-798-5798
Practice Address - Fax:601-798-5914
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily