Healthcare Provider Details

I. General information

NPI: 1104011238
Provider Name (Legal Business Name): ANN M CWIKLINSKI RN,APN,C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 12TH ST S
BRIGANTINE NJ
08203-2211
US

IV. Provider business mailing address

353 12TH ST S
BRIGANTINE NJ
08203-2211
US

V. Phone/Fax

Practice location:
  • Phone: 609-266-7557
  • Fax:
Mailing address:
  • Phone: 609-266-7557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NN05126100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: