Provider Demographics
NPI:1568635571
Name:FORD, CARMEN ROSE (ANP C)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:ROSE
Last Name:FORD
Suffix:
Gender:F
Credentials:ANP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 COLUMBIA TPKE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2113
Mailing Address - Country:US
Mailing Address - Phone:973-410-9700
Mailing Address - Fax:973-410-9703
Practice Address - Street 1:147 COLUMBIA TPKE
Practice Address - Street 2:SUITE 308
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2113
Practice Address - Country:US
Practice Address - Phone:973-410-9700
Practice Address - Fax:973-410-9703
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN06886100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health