Provider Demographics
NPI:1104163674
Name:PROCTOR, DENISE MARIE (FNP)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MARIE
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 OXFORD CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-3579
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:609-404-0506
Practice Address - Street 1:14 OXFORD CIR
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08088-3579
Practice Address - Country:US
Practice Address - Phone:609-388-4585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00403200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily