Healthcare Provider Details

I. General information

NPI: 1073072849
Provider Name (Legal Business Name): ANITA LYNN HERGERT MSN, RN, APN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 08/10/2024
Certification Date: 08/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 S MAIN ST
FORKED RIVER NJ
08731-4654
US

IV. Provider business mailing address

137 ATLANTIC CITY BLVD STE 1
BEACHWOOD NJ
08722-2935
US

V. Phone/Fax

Practice location:
  • Phone: 609-971-3500
  • Fax:
Mailing address:
  • Phone: 609-971-3500
  • Fax: 732-244-0046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number26NJ00910600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00910600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: