MEDICARE: JOANNA ENRIQUEZ 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	363LF0000X	Family Nurse Practitioner	26NJ00567800	NJ

General Provider Information

NPI Number	:	1366822744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA ENRIQUEZ APN

Provider Business Mailing Address
First Line	:	54 PLAUDERVILLE AVE STE 3
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-2252
Country	:	US
Telephone Number	:	973-772-0262
Fax Number	:	973-772-0265

Provider Business Practice Location Address
First Line	:	54 PLAUDERVILLE AVE STE 3
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-2252
Country	:	US
Telephone Number	:	973-772-0262
Fax Number	:	973-772-0265

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

Provider Enumeration Date	:	06/01/2015
Last Update Date	:	06/01/2015

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