Provider Demographics
NPI:1922433580
Name:VINCENT, JIJI (RN)
Entity Type:Individual
Prefix:
First Name:JIJI
Middle Name:
Last Name:VINCENT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JIJI
Other - Middle Name:
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:69 GOLD MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6530
Mailing Address - Country:US
Mailing Address - Phone:678-267-4164
Mailing Address - Fax:
Practice Address - Street 1:69 GOLD MAPLE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-6530
Practice Address - Country:US
Practice Address - Phone:678-267-4164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA214678163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse