Provider Demographics
NPI:1174281513
Name:DERRICK, AMY MARIE (APN)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:MARIE
Last Name:DERRICK
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 1:448 LUKAS BLVD
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-9741
Mailing Address - Country:US
Mailing Address - Phone:732-598-0340
Mailing Address - Fax:
Practice Address - Street 1:2640 HIGHWAY 70 STE 201
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-2609
Practice Address - Country:US
Practice Address - Phone:327-202-0622
Practice Address - Fax:732-202-0620
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18163900163W00000X
NJ26NJ14857300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse