Provider Demographics
NPI:1134568702
Name:INOCENCIO, MARK LAWRENCE (MSN, APN, FNP-C)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:LAWRENCE
Last Name:INOCENCIO
Suffix:
Gender:M
Credentials:MSN, APN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 AUDUBON AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1501
Mailing Address - Country:US
Mailing Address - Phone:201-805-7600
Mailing Address - Fax:
Practice Address - Street 1:533 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011
Practice Address - Country:US
Practice Address - Phone:973-546-6844
Practice Address - Fax:973-546-7707
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337685-1363LF0000X
NJ26NJ00398800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily