Provider Demographics
NPI:1932156551
Name:DI CECCO, JENNIFER T (CRNP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:T
Last Name:DI CECCO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39173 WHISPER WEST COURT
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669
Mailing Address - Country:US
Mailing Address - Phone:205-396-6992
Mailing Address - Fax:907-416-3345
Practice Address - Street 1:39173 WHISPER WEST COURT
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669
Practice Address - Country:US
Practice Address - Phone:205-396-6992
Practice Address - Fax:907-416-3345
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK200646363LP2300X
WAAP60814170363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891011490Medicaid