Provider Demographics
NPI:1073695391
Name:HAGGERTY, PATRICIA M (APN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 E LAUREL RD
Mailing Address - Street 2:UDP #1800
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1354
Mailing Address - Country:US
Mailing Address - Phone:856-566-6843
Mailing Address - Fax:856-566-6419
Practice Address - Street 1:42 E LAUREL RD
Practice Address - Street 2:UDP #1800
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-566-6843
Practice Address - Fax:856-566-6419
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05941900363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8721904Medicaid
NJ053659MX1Medicare PIN
NJ8721904Medicaid