Provider Demographics
NPI:1295071421
Name:GORDON DELOOPER, CAROL ANN (APN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:GORDON DELOOPER
Suffix:
Gender:F
Credentials:APN, FNP-BC
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:118 MINE RD
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-3706
Mailing Address - Country:US
Mailing Address - Phone:609-466-4624
Mailing Address - Fax:
Practice Address - Street 1:1435 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08629-2220
Practice Address - Country:US
Practice Address - Phone:609-599-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-16
Last Update Date:2013-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC06789100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily