Provider Demographics
NPI:1962945253
Name:PAPPAS, JACQUELINE ANN (FNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:PAPPAS
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 1:350 ENGLE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1808
Mailing Address - Country:US
Mailing Address - Phone:201-247-9616
Mailing Address - Fax:
Practice Address - Street 1:412 E 73RD ST
Practice Address - Street 2:APT 3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3853
Practice Address - Country:US
Practice Address - Phone:201-247-9616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00724300363L00000X
NYF3410811363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily