Provider Demographics
NPI:1093563322
Name:AMOFA, NICOLA SIMONE (RPN)
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:SIMONE
Last Name:AMOFA
Suffix:
Gender:F
Credentials:RPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 E JERSEY ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2431
Mailing Address - Country:US
Mailing Address - Phone:732-226-7643
Mailing Address - Fax:
Practice Address - Street 1:1139 E JERSEY ST STE 203
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2431
Practice Address - Country:US
Practice Address - Phone:732-226-7643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR14941500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse