Provider Demographics
NPI:1447276431
Name:MARINUCCI, ANGELA THERESA (NP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:THERESA
Last Name:MARINUCCI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-1828
Mailing Address - Country:US
Mailing Address - Phone:856-223-0908
Mailing Address - Fax:
Practice Address - Street 1:1527 FOREST GROVE RD
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-1865
Practice Address - Country:US
Practice Address - Phone:856-697-7490
Practice Address - Fax:856-697-7494
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00057800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0031313Medicaid
NJ0031313Medicaid
NJQ18958Medicare UPIN