Provider Demographics
NPI:1407390735
Name:D'SOUZA, ANNETTE ERIC (APN)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:ERIC
Last Name:D'SOUZA
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 1:9 HOSPITAL DR STE B1
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6425
Mailing Address - Country:US
Mailing Address - Phone:732-363-7200
Mailing Address - Fax:866-662-4129
Practice Address - Street 1:9 HOSPITAL DR STE B1
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6425
Practice Address - Country:US
Practice Address - Phone:732-363-7200
Practice Address - Fax:866-662-4129
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00683300363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0546691Medicaid
NJ2797003Medicaid