Provider Demographics
NPI:1255857694
Name:FLYNN, GRACE A (APN)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:A
Last Name:FLYNN
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 1:1474 TANYARD ROAD
Mailing Address - Street 2:SUITE C100
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-1573
Mailing Address - Country:US
Mailing Address - Phone:856-932-7476
Mailing Address - Fax:856-566-6320
Practice Address - Street 1:1474 TANYARD ROAD
Practice Address - Street 2:SUITE C100
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080
Practice Address - Country:US
Practice Address - Phone:856-932-7476
Practice Address - Fax:856-566-6320
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00723400363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner