MEDICARE: GINA PETRUCELLI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	26NJ15144200	NJ
2	363LF0000X	Family Nurse Practitioner	355584	NY

General Provider Information

NPI Number	:	1649167065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA PETRUCELLI

Provider Business Mailing Address
First Line	:	1134 SYLVAN DR
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-3035
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1134 SYLVAN DR
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-3035
Country	:	US
Telephone Number	:	516-578-9155
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2025
Last Update Date	:	06/15/2026

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Directions to “ GINA PETRUCELLI ” Practice Location

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