Healthcare Provider Details

I. General information

NPI: 1619426343
Provider Name (Legal Business Name): KRISTIN FIDUCIA APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MADISON ST
MORRISTOWN NJ
07960-5257
US

IV. Provider business mailing address

9 MADISON ST
MORRISTOWN NJ
07960-5257
US

V. Phone/Fax

Practice location:
  • Phone: 888-409-0801
  • Fax: 973-425-0453
Mailing address:
  • Phone: 888-409-0801
  • Fax: 973-425-0453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00670300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: