Provider Demographics
NPI:1871002139
Name:JEAN-CHARLES, IMMACULA (FNP)
Entity Type:Individual
Prefix:
First Name:IMMACULA
Middle Name:
Last Name:JEAN-CHARLES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 BRUNSWICK PIKE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4106
Mailing Address - Country:US
Mailing Address - Phone:609-882-2577
Mailing Address - Fax:
Practice Address - Street 1:338 CHIMNEY ROCK RD UNIT A140
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1286
Practice Address - Country:US
Practice Address - Phone:848-202-8494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341478363LF0000X
NJ26NJ00943600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily