Provider Demographics
NPI:1497851448
Name:VALLARTA, JAINA (RN, MSN, APRN-BC)
Entity Type:Individual
Prefix:
First Name:JAINA
Middle Name:
Last Name:VALLARTA
Suffix:
Gender:F
Credentials:RN, MSN, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PINE TREE DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5426
Mailing Address - Country:US
Mailing Address - Phone:973-567-8167
Mailing Address - Fax:
Practice Address - Street 1:8 PINE TREE DR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5426
Practice Address - Country:US
Practice Address - Phone:973-567-8167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR06482700163WC0200X
NJ26NJ00044400363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0039195Medicaid
NJ0039195Medicaid