Provider Demographics
NPI:1780335935
Name:ANNETT, JACELYN (APN)
Entity type:Individual
Prefix:
First Name:JACELYN
Middle Name:
Last Name:ANNETT
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 1:405 HURFFVILLE CROSSKEYS RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9344
Mailing Address - Country:US
Mailing Address - Phone:856-589-1414
Mailing Address - Fax:856-256-5772
Practice Address - Street 1:405 HURFFVILLE CROSSKEYS RD STE 202
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9344
Practice Address - Country:US
Practice Address - Phone:856-589-1414
Practice Address - Fax:856-256-5772
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01251200363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health