Provider Demographics
NPI:1174811095
Name:FLORES, MARY J (ANP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:J
Last Name:FLORES
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 GLENWOOD CT
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6105
Mailing Address - Country:US
Mailing Address - Phone:908-964-8866
Mailing Address - Fax:
Practice Address - Street 1:124 GLENWOOD CT
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6105
Practice Address - Country:US
Practice Address - Phone:908-964-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00319000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health