Provider Demographics
NPI:1730292269
Name:WOMBLE, INA E (APN)
Entity Type:Individual
Prefix:
First Name:INA
Middle Name:E
Last Name:WOMBLE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:INA
Other - Middle Name:E
Other - Last Name:TRIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:456 PORT MONMOUTH RD E
Mailing Address - Street 2:
Mailing Address - City:PORT MONMOUTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07758-1646
Mailing Address - Country:US
Mailing Address - Phone:732-787-9277
Mailing Address - Fax:612-659-7101
Practice Address - Street 1:3 CENTURY DR
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4610
Practice Address - Country:US
Practice Address - Phone:877-692-4665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333340-1363LF0000X
NJ26NC08044100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily