Provider Demographics
NPI:1760880728
Name:SANNICANDRO, JOLYNNE
Entity Type:Individual
Prefix:MRS
First Name:JOLYNNE
Middle Name:
Last Name:SANNICANDRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#617
Mailing Address - Street 2:387 POMPTON AVENUE
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1801
Mailing Address - Country:US
Mailing Address - Phone:973-857-2550
Mailing Address - Fax:
Practice Address - Street 1:#617
Practice Address - Street 2:387 POMPTON AVENUE
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1801
Practice Address - Country:US
Practice Address - Phone:973-857-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01310000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily