Provider Demographics
NPI:1639369879
Name:MINGHENELLI, TAMARA (APN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:MINGHENELLI
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 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:181 W WHITE HORSE PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-2032
Practice Address - Country:US
Practice Address - Phone:856-767-3234
Practice Address - Fax:856-767-3518
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ0061300364SF0001X
NJ26NJ00061300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health