Provider Demographics
NPI:1588617773
Name:SMITH, JENNIFER (ACNP,BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:ACNP,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 STELTON ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-2638
Mailing Address - Country:US
Mailing Address - Phone:732-424-0440
Mailing Address - Fax:732-424-0443
Practice Address - Street 1:24 STELTON ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-2638
Practice Address - Country:US
Practice Address - Phone:732-424-0440
Practice Address - Fax:732-424-0443
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00089000363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care