Healthcare Provider Details

I. General information

NPI: 1144713546
Provider Name (Legal Business Name): CAROLINE TAINTOR APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 JERSEY AVE
UNION BEACH NJ
07735-3322
US

IV. Provider business mailing address

608 JERSEY AVE
UNION BEACH NJ
07735-3322
US

V. Phone/Fax

Practice location:
  • Phone: 718-440-7564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00808100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: