Provider Demographics
NPI:1003338088
Name:SANTICCIOLI, JESSICA A (FNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:SANTICCIOLI
Suffix:
Gender:F
Credentials:FNP
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Other - Credentials:
Mailing Address - Street 1:145 ROSEMARY STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3259
Mailing Address - Country:US
Mailing Address - Phone:781-235-7900
Mailing Address - Fax:781-237-9930
Practice Address - Street 1:145 ROSEMARY STREET
Practice Address - Street 2:SUITE C
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3259
Practice Address - Country:US
Practice Address - Phone:781-235-7900
Practice Address - Fax:781-237-9930
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2025-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MARN2306669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110127465AMedicaid