Healthcare Provider Details

I. General information

NPI: 1962945253
Provider Name (Legal Business Name): JACQUELINE A SKOUFAS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELINE PAPPAS

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ENGLE STREET 5 MAIN
ENGLEWOOD NJ
07631
US

IV. Provider business mailing address

350 ENGLE ST
ENGLEWOOD NJ
07631-1808
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-3636
  • Fax:
Mailing address:
  • Phone: 201-247-9616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF3410811
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00724300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: