Provider Demographics
NPI:1780440313
Name:MENDOZA, GLADYS MARIA (FNP)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:MARIA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PRINCETON TER
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2102
Mailing Address - Country:US
Mailing Address - Phone:201-468-7093
Mailing Address - Fax:
Practice Address - Street 1:377 JERSEY AVE STE 310
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4397
Practice Address - Country:US
Practice Address - Phone:201-706-2091
Practice Address - Fax:201-706-2092
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15010400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily