MEDICARE: CAROLINE MAGNUAL APN-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	26NJ14956700	NJ
2	363LG0600X	Gerontology Nurse Practitioner	26NJ14956700	NJ
3	363LP2300X	Primary Care Nurse Practitioner	26NJ14956700	NJ
4	363LA2200X	Adult Health Nurse Practitioner	26NJ14956700	NJ

General Provider Information

NPI Number	:	1104687524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE MAGNUAL APN-C

Provider Business Mailing Address
First Line	:	PO BOX 593
Second Line	:
City	:	CAPE MAY COURT HOUSE
State	:	NJ
Zip	:	08210-0593
Country	:	US
Telephone Number	:	609-463-2755
Fax Number	:	609-463-2757

Provider Business Practice Location Address
First Line	:	4011 ROUTE 9 S STE 201
Second Line	:
City	:	RIO GRANDE
State	:	NJ
Zip	:	08242-1918
Country	:	US
Telephone Number	:	609-463-2273
Fax Number	:	609-770-7729

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	05/16/2024

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Directions to “ CAROLINE MAGNUAL APN-C” Practice Location

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