Provider Demographics
NPI:1760741714
Name:JIJO, MINI (MS,APN-C)
Entity Type:Individual
Prefix:
First Name:MINI
Middle Name:
Last Name:JIJO
Suffix:
Gender:F
Credentials:MS,APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:884 S SPRINGFIELD AVE
Mailing Address - Street 2:#39
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-3314
Mailing Address - Country:US
Mailing Address - Phone:908-635-2555
Mailing Address - Fax:
Practice Address - Street 1:884 SOUTH SPRINGFIELD AVE
Practice Address - Street 2:#39
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3314
Practice Address - Country:US
Practice Address - Phone:908-635-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00374400363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care