Provider Demographics
NPI:1174970305
Name:VANCE, CARYN ELISABETH (APN-C)
Entity type:Individual
Prefix:MISS
First Name:CARYN
Middle Name:ELISABETH
Last Name:VANCE
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 TARRAGON CT
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08086-2418
Mailing Address - Country:US
Mailing Address - Phone:609-221-7781
Mailing Address - Fax:
Practice Address - Street 1:600 JESSUP RD
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08066-2413
Practice Address - Country:US
Practice Address - Phone:856-845-4061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00641200363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health