Individual
JODIE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
100 BLACK HORSE PIKE, AUDUBON, NJ 08106-1950
(844) 542-2273
Mailing address
100 BLACK HORSE PIKE, AUDUBON, NJ 08106-1950
(844) 542-2273
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
26NJ00805900
NJ
207Q00000X
Family Medicine Physician
SP018556
PA
363LF0000X
Family Nurse Practitioner
Primary
26NJ00805900
NJ
Other
Enumeration date
03/05/2018
Last updated
03/04/2024
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