Provider Demographics
NPI:1366952137
Name:TORGBOR, JACQUELINE (PMHNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:TORGBOR
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7A BRYNWOOD GDNS APT 5
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2387
Mailing Address - Country:US
Mailing Address - Phone:646-683-0572
Mailing Address - Fax:
Practice Address - Street 1:7A BRYNWOOD GDNS APT 5
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2387
Practice Address - Country:US
Practice Address - Phone:646-683-0572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR16311400163W00000X
GA282894363LP0808X
NJ26NJ01269800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse