Provider Demographics
NPI:1528094752
Name:FITZGERALD, JANICE MURIEL (APN, FNP)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:MURIEL
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:APN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BORO COMMONS
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-2380
Mailing Address - Country:US
Mailing Address - Phone:856-863-1169
Mailing Address - Fax:856-863-1169
Practice Address - Street 1:25 BORO COMMONS
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-2380
Practice Address - Country:US
Practice Address - Phone:856-863-1169
Practice Address - Fax:856-863-1169
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09495000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ131245XVAMedicare UPIN
MAP44329Medicare UPIN
MAFI NP3602Medicare ID - Type UnspecifiedMEDICARE PART B