Healthcare Provider Details

I. General information

NPI: 1780335935
Provider Name (Legal Business Name): JACELYN ANNETT APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 HURFFVILLE CROSSKEYS RD STE 202
SEWELL NJ
08080-9344
US

IV. Provider business mailing address

405 HURFFVILLE CROSSKEYS RD STE 202
SEWELL NJ
08080-9344
US

V. Phone/Fax

Practice location:
  • Phone: 856-589-1414
  • Fax: 856-256-5772
Mailing address:
  • Phone: 856-589-1414
  • Fax: 856-256-5772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number26NJ01251200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: