Provider Demographics
NPI:1043712003
Name:GROOMS, RAFIA NICOLA (DNP)
Entity type:Individual
Prefix:
First Name:RAFIA
Middle Name:NICOLA
Last Name:GROOMS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-3897
Mailing Address - Country:US
Mailing Address - Phone:215-888-5605
Mailing Address - Fax:
Practice Address - Street 1:432 GANTTOWN RD STE 103
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-1895
Practice Address - Country:US
Practice Address - Phone:856-965-1000
Practice Address - Fax:856-965-1001
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018667363LF0000X
NJ26NJ00854600363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily