Provider Demographics
NPI:1255857694
Name:FLYNN, GRACE A (APN)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:A
Last Name:FLYNN
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 1:15000 MIDLANTIC DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1573
Mailing Address - Country:US
Mailing Address - Phone:855-727-2465
Mailing Address - Fax:
Practice Address - Street 1:151 FRIES MILL RD STE 202
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2057
Practice Address - Country:US
Practice Address - Phone:855-727-2465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00723400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner