Provider Demographics
NPI:1730769282
Name:KUSTEK, JESSICA (AGNP BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KUSTEK
Suffix:
Gender:F
Credentials:AGNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 ENGLISH CREEK AVE
Mailing Address - Street 2:SUITE 604
Mailing Address - City:EGG HARBOR TNP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234
Mailing Address - Country:US
Mailing Address - Phone:609-485-0885
Mailing Address - Fax:609-485-0882
Practice Address - Street 1:2500 ENGLISH CREEK AVE
Practice Address - Street 2:SUITE 604
Practice Address - City:EGG HARBOR TNP
Practice Address - State:NJ
Practice Address - Zip Code:08234
Practice Address - Country:US
Practice Address - Phone:609-485-0885
Practice Address - Fax:609-485-0882
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01107700363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology