Provider Demographics
NPI:1952060923
Name:FARAGASSO, LINDA L (APN)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:L
Last Name:FARAGASSO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:609-822-3027
Mailing Address - Fax:609-822-5195
Practice Address - Street 1:6508 VENTNOR AVE
Practice Address - Street 2:
Practice Address - City:VENTNOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08406-2177
Practice Address - Country:US
Practice Address - Phone:609-822-3027
Practice Address - Fax:609-822-5195
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01222100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily