Provider Demographics
NPI:1821028432
Name:HAINES, JESSICA (APN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HAINES
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 1:76 STIRLING RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5778
Mailing Address - Country:US
Mailing Address - Phone:908-755-3457
Mailing Address - Fax:908-755-6905
Practice Address - Street 1:76 STIRLING RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5778
Practice Address - Country:US
Practice Address - Phone:908-755-3457
Practice Address - Fax:908-755-6905
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00318600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMH1389279OtherDEA