Provider Demographics
NPI:1740507888
Name:RIZZOTTE, JESSICA A (CPNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:RIZZOTTE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:GOODFELLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:1483 W. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371
Mailing Address - Country:US
Mailing Address - Phone:937-667-7711
Mailing Address - Fax:937-667-8067
Practice Address - Street 1:1483 W. MAIN ST
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371
Practice Address - Country:US
Practice Address - Phone:937-667-7711
Practice Address - Fax:937-667-8067
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.09605-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics