Provider Demographics
NPI:1174039218
Name:DISALVO, JOANNA MARIE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:MARIE
Last Name:DISALVO
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 OLD HOOK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-2622
Mailing Address - Country:US
Mailing Address - Phone:201-857-5620
Mailing Address - Fax:
Practice Address - Street 1:390 OLD HOOK RD STE 101
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-2622
Practice Address - Country:US
Practice Address - Phone:201-857-5620
Practice Address - Fax:201-857-5562
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00792300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily