Healthcare Provider Details

I. General information

NPI: 1437653425
Provider Name (Legal Business Name): DONNA MARIE MCKINNON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1868 HOOPER AVE
TOMS RIVER NJ
08753
US

IV. Provider business mailing address

1868 HOOPER AVE
TOMS RIVER NJ
08753-8175
US

V. Phone/Fax

Practice location:
  • Phone: 848-223-7120
  • Fax:
Mailing address:
  • Phone: 848-223-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00811900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: