Healthcare Provider Details

I. General information

NPI: 1932694460
Provider Name (Legal Business Name): MELISSA MORINA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 S EVERGREEN AVE
WOODBURY NJ
08096
US

IV. Provider business mailing address

307 S EVERGREEN AVE
WOODBURY NJ
08096-2739
US

V. Phone/Fax

Practice location:
  • Phone: 856-848-3817
  • Fax:
Mailing address:
  • Phone: 856-848-3817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00866800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: