Provider Demographics
NPI:1447403639
Name:NERSITA, COLLEEN (APN)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:NERSITA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:DEMARTINIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:101 OLD SHORT HILLS RD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1000
Mailing Address - Country:US
Mailing Address - Phone:973-736-1100
Mailing Address - Fax:973-736-1834
Practice Address - Street 1:101 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE 410
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1000
Practice Address - Country:US
Practice Address - Phone:973-736-1100
Practice Address - Fax:973-736-1834
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00055100363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology