Provider Demographics
NPI:1841725470
Name:LAUGHLIN, JODI (FNP)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:LAUGHLIN
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 1:400 HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077
Mailing Address - Country:US
Mailing Address - Phone:856-296-4736
Mailing Address - Fax:
Practice Address - Street 1:401 YOUNG AVE SUITE 180 FRONT
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057
Practice Address - Country:US
Practice Address - Phone:856-291-8600
Practice Address - Fax:856-291-8610
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017170363LF0000X
NJ26NJ00721900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0591211Medicaid