Healthcare Provider Details

I. General information

NPI: 1902221864
Provider Name (Legal Business Name): CICILY JEANNETTE DNP, APN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2848 S DELSEA DR STE 2C
VINELAND NJ
08360-7042
US

IV. Provider business mailing address

2848 S DELSEA DR STE 2C
VINELAND NJ
08360-7042
US

V. Phone/Fax

Practice location:
  • Phone: 856-794-5180
  • Fax:
Mailing address:
  • Phone: 856-794-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number11293198
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number26NR13823300
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number26NJ00829100
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00829100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: