Healthcare Provider Details

I. General information

NPI: 1225961386
Provider Name (Legal Business Name): JANSENIA DIANE MILLARES MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 POMPTON RD
WAYNE NJ
07470-2103
US

IV. Provider business mailing address

2517 JOHN F KENNEDY BLVD
JERSEY CITY NJ
07304-2005
US

V. Phone/Fax

Practice location:
  • Phone: 973-720-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360076
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: