Healthcare Provider Details

I. General information

NPI: 1922722958
Provider Name (Legal Business Name): GRETCHEN NICOLOSI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 STATE ROUTE 36
ATLANTIC HIGHLANDS NJ
07716-2469
US

IV. Provider business mailing address

1012 STATE ROUTE 36
ATLANTIC HIGHLANDS NJ
07716-2469
US

V. Phone/Fax

Practice location:
  • Phone: 732-291-3865
  • Fax: 732-291-3859
Mailing address:
  • Phone: 732-291-3865
  • Fax: 732-291-3859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ01376600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: