MEDICARE: NINA THOMPSON APN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ15120100	NJ

General Provider Information

NPI Number	:	1326871088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA THOMPSON APN

Provider Business Mailing Address
First Line	:	54 SAVANNAH DR
Second Line	:
City	:	BARNEGAT
State	:	NJ
Zip	:	08005-1351
Country	:	US
Telephone Number	:	732-503-5110
Fax Number	:	201-751-1680

Provider Business Practice Location Address
First Line	:	1173 BEACON AVE STE A
Second Line	:
City	:	MANAHAWKIN
State	:	NJ
Zip	:	08050-2531
Country	:	US
Telephone Number	:	732-503-5110
Fax Number	:	609-978-4321

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

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	01/02/2026

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