Healthcare Provider Details

I. General information

NPI: 1962136994
Provider Name (Legal Business Name): JO ANN LIMOS DAQUIZ APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 CHESTNUT ST
BRIDGEWATER NJ
08807-2700
US

IV. Provider business mailing address

143 CHESTNUT ST
BRIDGEWATER NJ
08807-2700
US

V. Phone/Fax

Practice location:
  • Phone: 201-892-8909
  • Fax:
Mailing address:
  • Phone: 201-892-8909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01333500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: