Provider Demographics
NPI:1366224834
Name:HOLZBAUR, JACQUELINE SUMMER (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SUMMER
Last Name:HOLZBAUR
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SAMANTHA LN
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-4312
Mailing Address - Country:US
Mailing Address - Phone:609-815-6653
Mailing Address - Fax:
Practice Address - Street 1:12 SAMANTHA LN
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-4312
Practice Address - Country:US
Practice Address - Phone:609-815-6653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18821500163W00000X
PARN689119163W00000X
NJ26NJ14939800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse