Provider Demographics
NPI:1740061308
Name:WALCZAK, JOANNA (AGAC-NP)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:
Last Name:WALCZAK
Suffix:
Gender:F
Credentials:AGAC-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-9728
Mailing Address - Country:US
Mailing Address - Phone:609-576-0428
Mailing Address - Fax:
Practice Address - Street 1:20 MOUNTAIN LN
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08234-9728
Practice Address - Country:US
Practice Address - Phone:609-576-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01306800363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology