Provider Demographics
NPI:1710037163
Name:MADDOX VANN, JESSICA ARBETH (APN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ARBETH
Last Name:MADDOX VANN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:ARBETH
Other - Last Name:MADDOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GNP-BC
Mailing Address - Street 1:106 LUPINE LN
Mailing Address - Street 2:
Mailing Address - City:PENNS GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08069-2241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 LUPINE LN
Practice Address - Street 2:
Practice Address - City:PENNS GROVE
Practice Address - State:NJ
Practice Address - Zip Code:08069-2241
Practice Address - Country:US
Practice Address - Phone:609-617-5229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2011-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008840363LG0600X
NJ26NJ00325000363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology