Provider Demographics
NPI:1588074173
Name:CIRINO THOMAS, CHARMAINE M (FNP - BC)
Entity type:Individual
Prefix:MRS
First Name:CHARMAINE
Middle Name:M
Last Name:CIRINO THOMAS
Suffix:
Gender:F
Credentials:FNP - BC
Other - Prefix:
Other - First Name:CHARMAINE
Other - Middle Name:CIRINO
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:201 MULLICA HILL RD
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-1700
Mailing Address - Country:US
Mailing Address - Phone:856-256-4333
Mailing Address - Fax:856-256-4427
Practice Address - Street 1:201 MULLICA HILL RD
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-1700
Practice Address - Country:US
Practice Address - Phone:856-256-4333
Practice Address - Fax:856-256-4427
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00537300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0449555Medicaid
NJ403876ABNMedicare Oscar/Certification