Healthcare Provider Details

I. General information

NPI: 1275026601
Provider Name (Legal Business Name): GIANNA VALERIE POTTS MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 S MAIN ST
FORKED RIVER NJ
08731-4654
US

IV. Provider business mailing address

9 BLUE CLAW DR
BARNEGAT NJ
08005-1507
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NR12363900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: