Provider Demographics
NPI:1922585850
Name:HARGRAVES, AMANDA U (APN)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:U
Last Name:HARGRAVES
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 1:444 NEPTUNE BLVD.
Mailing Address - Street 2:UNIT 2
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4144
Mailing Address - Country:US
Mailing Address - Phone:732-775-5300
Mailing Address - Fax:732-775-1737
Practice Address - Street 1:444 NEPTUNE BLVD.
Practice Address - Street 2:UNIT 2
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4144
Practice Address - Country:US
Practice Address - Phone:732-775-5300
Practice Address - Fax:732-775-1737
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00830600363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8880107Medicaid