Provider Demographics
NPI:1740288406
Name:STAFFORD, EMMA C (RN, APNC)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:C
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:RN, APNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SOUTH COOKS BRIDGE ROAD
Mailing Address - Street 2:SUITE 2-3
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2524
Mailing Address - Country:US
Mailing Address - Phone:732-994-7855
Mailing Address - Fax:732-242-6688
Practice Address - Street 1:444 NEPTUNE BLVD FL 2
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4800
Practice Address - Country:US
Practice Address - Phone:732-775-5300
Practice Address - Fax:732-775-1737
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00016400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8911703Medicaid
NJ8911703Medicaid
NJ058950QQPMedicare ID - Type Unspecified