Healthcare Provider Details

I. General information

NPI: 1366021222
Provider Name (Legal Business Name): TINA MARIE JAMES MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 CLINTON AVE
IRVINGTON NJ
07111-2010
US

IV. Provider business mailing address

1123 CLINTON AVE
IRVINGTON NJ
07111-2010
US

V. Phone/Fax

Practice location:
  • Phone: 732-582-5964
  • Fax: 732-369-9047
Mailing address:
  • Phone: 732-582-5964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01138800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR17629700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: