Active NPI
Jake Wallace Carzoli, FNP-C
- Nurse Practitioner
- Vancleave, MS
National Provider Identifier
1548761950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 902499
- Practice address
- 11700 Ms-57
Vancleave, MS 39565 - Phone
- (228) 826-1482
- NPI assigned
- Feb 22, 2018
- Last updated
- Feb 22, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 902499 | MS | Primary |
Addresses
Primary practice location
11700 Ms-57
Vancleave, MS 39565
Mailing address
509 Palm Breeze Dr
Ocean Springs, MS 39564-5532
Phone (334) 728-0421
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519257600000",
"number": "1548761950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "509 PALM BREEZE DR",
"city": "OCEAN SPRINGS",
"state": "MS",
"postal_code": "395645532",
"telephone_number": "334-728-0421"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11700 MS-57",
"city": "VANCLEAVE",
"state": "MS",
"postal_code": "39565",
"telephone_number": "228-826-1482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARZOLI",
"first_name": "JAKE",
"middle_name": "WALLACE",
"name_prefix": "Mr.",
"credential": "FNP-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-02-22",
"last_updated": "2018-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MS",
"license": "902499",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancleave, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.