Provider Demographics
NPI:1912263377
Name:JANDIK, STACIE (DNP, FNP, APN)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:JANDIK
Suffix:
Gender:F
Credentials:DNP, FNP, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 BURNT TAVERN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-2014
Mailing Address - Country:US
Mailing Address - Phone:732-814-7924
Mailing Address - Fax:
Practice Address - Street 1:989 BURNT TAVERN RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-2014
Practice Address - Country:US
Practice Address - Phone:732-836-3049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00391200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily