Provider Demographics
NPI:1639243892
Name:VIRGILIO, ANITA (RN,MSN,APN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:VIRGILIO
Suffix:
Gender:F
Credentials:RN,MSN,APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:MARMORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08223-1118
Mailing Address - Country:US
Mailing Address - Phone:609-390-7918
Mailing Address - Fax:
Practice Address - Street 1:4 MOORE RD
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-1654
Practice Address - Country:US
Practice Address - Phone:609-465-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN08200200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ855618Medicare ID - Type Unspecified