Provider Demographics
NPI:1437756954
Name:TEJADA, MARIA J (ADVANCED PRACTICE RN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:J
Last Name:TEJADA
Suffix:
Gender:F
Credentials:ADVANCED PRACTICE RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 KIM LN
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6376
Mailing Address - Country:US
Mailing Address - Phone:848-448-1067
Mailing Address - Fax:
Practice Address - Street 1:1163 ROUTE 37 W STE D4
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-4975
Practice Address - Country:US
Practice Address - Phone:732-341-9494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01055100363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty