Provider Demographics
NPI:1205652054
Name:ACEVEDO, MARIELY (FNP-C)
Entity type:Individual
Prefix:
First Name:MARIELY
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 APPLEGARTH RD STE B
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-3822
Mailing Address - Country:US
Mailing Address - Phone:609-908-4571
Mailing Address - Fax:
Practice Address - Street 1:298 APPLEGARTH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-3821
Practice Address - Country:US
Practice Address - Phone:609-908-4571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15203800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily