Provider Demographics
NPI:1467726364
Name:LINCOLN, JENNIFER REBECCA (PA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:REBECCA
Last Name:LINCOLN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 DELSEA DR STE B
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9478
Mailing Address - Country:US
Mailing Address - Phone:856-302-0500
Mailing Address - Fax:856-302-0504
Practice Address - Street 1:150 DELSEA DR STE B
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9478
Practice Address - Country:US
Practice Address - Phone:856-302-0500
Practice Address - Fax:856-302-0504
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5051363AM0700X
CAPA21920363AM0700X
NJ25MP00458600363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical