Healthcare Provider Details

I. General information

NPI: 1336532126
Provider Name (Legal Business Name): SHIRLEY VINCENT DNP, MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 04/24/2023
Certification Date: 04/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 DICKINSON ST
ELIZABETH NJ
07201-2210
US

IV. Provider business mailing address

28 CELEBRATION LN
STATEN ISLAND NY
10304-4615
US

V. Phone/Fax

Practice location:
  • Phone: 908-354-8900
  • Fax: 908-354-0007
Mailing address:
  • Phone: 917-415-3215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF337495
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: