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General NPI Number Information
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NPI Number | 1497299390
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Entity Type | Individual
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Provider Name | JENNIFER RAE APN
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Gender | Female
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Dates
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Enumeration Date | 12/12/2016
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1691 US HIGHWAY 9
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City | TOMS RIVER
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State | NJ
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Zip | 08755-1245
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Country | US
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Telephone | 732-914-1688
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Fax |
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Provider Business Mailing Address
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Address Line | 9 OCEAN BREEZE CT
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-3346
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Country | US
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Telephone | 908-902-3534
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 26NJ00687900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00687900
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License Number State | NJ
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