Provider Demographics
NPI:1023629920
Name:DINNOCENZIO, CAROL ANNA (DNP, APN)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANNA
Last Name:DINNOCENZIO
Suffix:
Gender:F
Credentials:DNP, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1601
Mailing Address - Country:US
Mailing Address - Phone:732-221-4492
Mailing Address - Fax:
Practice Address - Street 1:2 LINCOLN HWY STE 301
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3904
Practice Address - Country:US
Practice Address - Phone:732-549-7380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01046700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily