Provider Demographics
NPI:1619042942
Name:MULFORD, JACINDA L (APN)
Entity Type:Individual
Prefix:
First Name:JACINDA
Middle Name:L
Last Name:MULFORD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:2038 CARMEL ROAD
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-0808
Mailing Address - Country:US
Mailing Address - Phone:856-825-6810
Mailing Address - Fax:856-327-4281
Practice Address - Street 1:2038 CARMEL ROAD
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332
Practice Address - Country:US
Practice Address - Phone:856-825-6810
Practice Address - Fax:856-327-4281
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC10462200364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent