Provider Demographics
NPI:1184143505
Name:TOMAS, JACKELINE (APN)
Entity type:Individual
Prefix:
First Name:JACKELINE
Middle Name:
Last Name:TOMAS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 PINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1422
Mailing Address - Country:US
Mailing Address - Phone:201-755-0793
Mailing Address - Fax:
Practice Address - Street 1:777 TERRACE AVE STE 311
Practice Address - Street 2:
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604-3112
Practice Address - Country:US
Practice Address - Phone:201-288-4252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00740200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner