Provider Demographics
NPI:1922722958
Name:NICOLOSI, GRETCHEN (APN)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:
Last Name:NICOLOSI
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 1:1012 STATE ROUTE 36
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-2469
Mailing Address - Country:US
Mailing Address - Phone:732-291-3865
Mailing Address - Fax:732-291-3859
Practice Address - Street 1:1012 STATE ROUTE 36
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-2469
Practice Address - Country:US
Practice Address - Phone:732-291-3865
Practice Address - Fax:732-291-3859
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01376600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health