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General NPI Number Information
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NPI Number | 1912564428
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Entity Type | Individual
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Provider Name | JAN FORD NP
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Gender | Female
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Dates
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Enumeration Date | 05/21/2019
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 500 MAIN ST STE 1
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City | LANOKA HARBOR
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State | NJ
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Zip | 08734-2228
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Country | US
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Telephone | 732-719-1920
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Fax | 732-719-1920
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Provider Business Mailing Address
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Address Line | 500 MAIN ST STE 1
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City | LANOKA HARBOR
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State | NJ
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Zip | 08734-2228
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Country | US
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Telephone | 732-719-1920
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Fax | 732-719-1920
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ00922600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00922600
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License Number State | NJ
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