Provider Demographics
NPI:1457850141
Name:DIAZ, JOHANNELDA JAMORA (MSN-FNP)
Entity Type:Individual
Prefix:
First Name:JOHANNELDA
Middle Name:JAMORA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MSN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-4808
Mailing Address - Country:US
Mailing Address - Phone:609-491-1321
Mailing Address - Fax:
Practice Address - Street 1:1440 PENNINGTON RD STE 1
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-2669
Practice Address - Country:US
Practice Address - Phone:609-890-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00790600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily