Provider Demographics
NPI:1962153163
Name:EDMONDS-DURAND, TOMIKO NICOLE (DNP APRN AGPCNP-C)
Entity type:Individual
Prefix:DR
First Name:TOMIKO
Middle Name:NICOLE
Last Name:EDMONDS-DURAND
Suffix:
Gender:F
Credentials:DNP APRN AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 WINFIELD TER
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7250
Mailing Address - Country:US
Mailing Address - Phone:908-380-8130
Mailing Address - Fax:
Practice Address - Street 1:253 WINFIELD TER
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7250
Practice Address - Country:US
Practice Address - Phone:908-380-8130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-10
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01411300363LA2200X
NJ26NR11464100163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology