Provider Demographics
NPI:1184461899
Name:PASSARIELLO, JACQUELINE MARISA (APN/RNFA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARISA
Last Name:PASSARIELLO
Suffix:
Gender:F
Credentials:APN/RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 ROUTE 34 S
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1444
Mailing Address - Country:US
Mailing Address - Phone:732-974-0404
Mailing Address - Fax:732-449-4271
Practice Address - Street 1:2315 ROUTE 34 S
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1444
Practice Address - Country:US
Practice Address - Phone:732-974-0404
Practice Address - Fax:732-449-4271
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR21176200163WR0006X
NJ26NJ15155900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant