Healthcare Provider Details

I. General information

NPI: 1619754579
Provider Name (Legal Business Name): JULIANNA HARKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S ORANGE AVE
SOUTH ORANGE NJ
07079-2646
US

IV. Provider business mailing address

400 S ORANGE AVE
SOUTH ORANGE NJ
07079-2646
US

V. Phone/Fax

Practice location:
  • Phone: 908-868-3884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ15420500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number26NR18774700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: