Provider Demographics
NPI:1891969374
Name:AMBROSE, EVELYN TASHJIAN (ADVANCE PRACTICE NUR)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:TASHJIAN
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:ADVANCE PRACTICE NUR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:249 UNIVERSITY AVE
Mailing Address - Street 2:RUTGERS UNIVERSITY HEALTH SERVICES RM 104
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-1808
Mailing Address - Country:US
Mailing Address - Phone:973-353-5231
Mailing Address - Fax:973-353-1390
Practice Address - Street 1:249 UNIVERSITY AVE
Practice Address - Street 2:RUTGERS UNIVERSITY HEALTH SERVICES RM 104
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1808
Practice Address - Country:US
Practice Address - Phone:973-353-5231
Practice Address - Fax:973-353-1390
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NN02749100364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health